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Lamotrigine Combined with Divalproex or Lithium for Bipolar Disorder: A Case Series
- James R. Redmond, Katrina L. Jamison, Charles L. Bowden
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- Journal:
- CNS Spectrums / Volume 11 / Issue 12 / December 2006
- Published online by Cambridge University Press:
- 07 November 2014, pp. 915-918
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Objective
To assess the efficacy of lamotrigine combined with either divalproex or lithium for the treatment of bipolar disorder.
IntroductionLithium and divalproex seem to be predominantly effective for manic and mixed symptoms of bipolar disorder, whereas lamotrigine may be more effective for bipolar depression than for mania. Combination therapy may provide more efficacious treatment for many patients with bipolar disorder.
MethodsData from charts of adult outpatients with bipolar disorder treated with lamotrigine plus divalproex or lithium during a 3-year period were retrospectively analyzed. The Clinical Global Impressions for Bipolar Disorder scale was used to assess severity of illness at baseline (adjunct-therapy initiation) and improvement after 3 months of treatment. The safety and tolerability of the medication combinations were assessed.
ResultsAfter 3 months of treatment, 26 of 39 patients (67%) receiving lamotrigine plus divalproex had a depression rating of 1 (very much improved) or 2 (much improved) compared with seven of 16 (44%) taking lamotrigine plus lithium. The mania rating was 1 or 2 for 13 of 39 (39%) patients treated with lamotrigine plus divalproex and 7 of 16 (44%) patients receiving lamotrigine plus lithium. For overall illness severity, 26 of 39 (67%) patients given lamotrigine plus divalproex had scores of 1 or 2 compared with 10 of 16 (62%) patients taking lamotrigine plus lithium. Five of 39 patients (13%) taking lamotrigine plus divalproex and 5 of 16 (31%) receiving lamotrigine plus lithium discontinued at least one part of the combination in <3 months due to adverse events.
ConclusionCombination therapy with lamotrigine plus divalproex or lithium may be a valuable option for managing symptoms of bipolar disorder. The combinations were generally well tolerated and apparently effective in improving depression as well as mania.The percentage of patients showing improvement in depression was somewhat larger. Tolerability was somewhat better for lamotrigine plus divalproex in combination than for lamotrigine plus lithium. Differences in tolerability are consistent with studies indicating poorer tolerability of lithium compared with divalproex.
Lamotrigine Augmentation Strategy for Patients with Treatment-Resistant Depression
- Rosben L. Gutierrez, Ruth McKercher, Jason Galea, Katrina L. Jamison
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- Journal:
- CNS Spectrums / Volume 10 / Issue 10 / October 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 800-805
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Objective:
To investigate if lamotrigine added to an antidepressant regimen reduces the symptoms of major depression in treatment-resistant patients.
Introduction:Charts were retrospectively reviewed for 34 patients (36–63 years of age) with major depressive disorder who received lamotrigine augmentation to the antidepressant regimen for treatment-resistant depression (TRD). Data collection occurred at baseline and at an average of 30 (Time 2), 78 (Time 3), 167 (Time 6), and 356 days (Time 12), thereafter, using a “Medication Visit by MD” scale for collection of target symptom data at each timepoint.
Results:Following the addition of lamotrigine to the antidepressant regimen (mean dose of 43, 63, and 113 mg/day for Time 3, Time 6, and Time 12, respectively), a statistically significant reduction of scores was shown as early as Time 2 for target symptoms of depressed mood, loss of interest, anxiety, irritability, (low) energy, and cognitive impairment. The difference from baseline remained statistically significant at Time 3, Time 6, and Time 12 (with the exception of irritability, which was not statistically significant at Time 6). “Patient's response” also reflected statistically significant improvement at each time period compared with baseline. The most common side effect reported and reason for discontinuation was tiredness.
Discussion:Because TRD is a clinical condition that can present with severe and disabling symptoms, many clinicians are faced with an urgent need to find relief for their patients. Trying to achieve symptom improvement in a timely manner during a medication change can be challenging and difficult. This can be managed by an augmentation strategy using a psychotropic add-on to an existing medication regimen. Our results show the benefits of lamotrigine augmentation to an antidepressant regimen. Prospective, controlled clinical trials with larger sample size are needed to confirm our results.
Conclusion:In this retrospective chart review, augmentation with lamotrigine was a tolerable and efficacious strategy for treating patients with TRD.
Retrospective Case Review of Lamotrigine Use for Affective Instability of Borderline Personality Disorder
- Wendy Weinstein, Katrina L. Jamison
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- Journal:
- CNS Spectrums / Volume 12 / Issue 3 / March 2007
- Published online by Cambridge University Press:
- 07 November 2014, pp. 207-210
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Introduction: The diagnosis of borderline personality disorder is complex as is its pharmacologic treatment. Lamotrigine may offer promise in the treatment of this condition.
Objective: To assess the use of lamotrigine to treat symptoms of affective instability in patients with borderline personality disorder.
Methods: Charts of patients treated with lamotrigine in a private practice during the period of 2003–2004 were reviewed. Patients were included in the analysis if they had been given a clinical diagnosis of borderline personality disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, had continued to display affective instability while taking their previous medications before being treated with lamotrigine; had received a Clinical Global Impression-Severity score before and after lamotrigine therapy; had been treated with lamotrigine, as monotherapy or adjunctive therapy, at a dose ranging from 50–200 mg/day; and continued to take lamotrigine for at least 3 months.
Results: The charts of 13 patients were reviewed and included in the analysis. All patients were female, 19–43 years of age, and had reported continuing symptoms of affective instability despite treatment with two to seven psychotropic drugs, including, but not limited to, fluoxetine, paroxetine, escitalopram, buproprion, and clonazepan. The duration of lamotrigine treatment, before the end of the period covered by the chart review was 3–15 months. The patients had initial Clinical Global Impression-Severity scores of 5 or 6 and a final scores of 1 or 2, except for one patient with an initial score of 3 and a final score of 1 and one patient with an initial score of 6 and a final score of 7.
Conclusion: Lamotrigine seems to be a safe and effective option for the treatment of patients with symptoms of affective instability associated with borderline personality disorder.