Spectrum of activity of lamotrigine in treatment-refractory bipolar disorder.
ABSTRACT New mood stabilizers are needed that possess efficacy for all phases of bipolar disorder. This study was designed to provide preliminary evidence for the safety and efficacy of a new anticonvulsant, lamotrigine, in adult patients with bipolar disorder who had been inadequately responsive to or intolerant of prior pharmacotherapy.
A 48-week, open-label, prospective trial was conducted in 75 patients with bipolar I or bipolar II disorder. Lamotrigine was used as adjunctive therapy (N = 60) or monotherapy (N = 15) in patients presenting in depressed, hypomanic, manic, or mixed states.
Of the 40 depressed patients included in the efficacy analysis, 48% exhibited a marked response and 20% a moderate response as measured by reductions in 17-item Hamilton Depression Rating Scale scores. Of the 31 with a hypomanic, manic, or mixed state, 81% displayed a marked response and 3% a moderate response on the Mania Rating Scale. From baseline to endpoint, the depressed patients exhibited a 42% decrease in Hamilton depression scale scores, and the patients presenting with hypomania, mania, or a mixed state exhibited a 74% decrease in Mania Rating Scale scores. The most common drug-related adverse events were dizziness, tremor, somnolence, headache, nausea, and rash. Rash was the most common adverse event resulting in drug discontinuation (9% of patients); one patient developed a serious rash and required hospitalization.
These open-label data provide preliminary evidence that lamotrigine may be an effective treatment option for patients with refractory bipolar disorder; however, potential benefits must be weighed against potential side effects, including rash.
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ABSTRACT: A clinical case-report is presented to discuss the evolution of the mixed state concept and the limitations faced on its clinical management. It is emphasized the role of electroconvulsive therapy on this case. The following data were obtained by patient and family interview as well as medical notes.Revista de Psiquiatria Clínica 12/2005; 32(6):336-340. DOI:10.1590/S0101-60832005000600005 · 0.89 Impact Factor
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ABSTRACT: We systematically reviewed studies to provide current evidence on the incidence and risk of skin rash in patients with LTG therapy. PubMed and Scopus databases, up to 15 March 2014 were searched to identify relevant studies. Eligible studies included prospective studies, retrospective studies and postmarketing reports, which included data of skin rash in patients with LTG therapy. Forty-one articles met the entry criteria. A total of 4447 patients with LTG therapy from 26 prospective studies, 2977 patients from 8 retrospective studies, and 26,126 patients from 5/7 postmarketing reports were included. The overall incidence of skin rash with LTG therapy was 9.98% (444/4447) from prospective studies, 7.19% (214/2977) from retrospective studies, and 2.09% (547/26,126) from postmarketing reports. A meta-analysis of the risk of skin rash in 21 prospective studies, did not show a significant difference between patients with LTG and other drugs, including placebo, other ADEs or lithium (OR 0.99-2.41). In 6 respective studies, there was a significantly higher OR in patients with LTG compared with those with non-aromatic AEDs. However, there was no significant difference in rash risk between patients with LTG and aromatic AEDs. Our study showed that LTG significantly increased the risk of developing a skin rash compared to non-aromatic AEDs. Our results support the need for large prospective population-based studies and clinical trials to determine whether LTG increases the risk of developing a skin rash than compared to other drugs. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.Seizure 02/2015; 25:52-61. DOI:10.1016/j.seizure.2014.12.001 · 2.06 Impact Factor
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ABSTRACT: The anticonvulsants, such as carbamazepine and sodium válproate, have been used for decades in the treatment of different psychiatric pathologies, especiálly in affective disorders and personálity disorders. Recently new antiepileptics such as oxcarhazepine, lamotrigine, gabapentin and topiramate have been marketed. The presera article reuiews the pharmacoki-netic properties and pharmacodyna-mics ofthese producís, the main stu-dies puhlished ahout their effective-ness in the treatment of bipolar di-sorder and acate manía, their probable therapeutic indications, and their most common adverse effects.09/2002; 31(3):237-246.