Bipolar disorder is frequently associated with obsessional symptoms. However, no reports have identified a pattern of obsessionality that is associated with a specific mood stabilizer treatment.
A chart review was conducted on five patients with bipolar II disorder who spontaneously reported a form of obsessionality characterized by intrusive, recurrent phrases after taking lamotrigine.
Development of the phrases occurred from 7-42 years after mood disorder onset and occurred only after initiation of lamotrigine treatment. The phrases improved with lamotrigine discontinuation or dose reduction and recurred with lamotrigine re-challenge or upon dose escalation.
A possible mechanism for the development of the intrusive phrases involves the influence of lamotrigine on glutamatergic regulation in a bipolar II disorder population vulnerable to the expression of obsessionality. Limitations of this report include its observational nature, small number of cases reported, and confound of concomitant medication use.
"In that case, it was hypothesized that LTG inhibited the presynaptic release of glutamate with altered striatal dopamine uptake, which again is relevant to the reputed cause of gambling associated with Parkinson's disease and dopaminergic therapy. Others  have also Epilepsy & Behavior Case Reports 2 (2014) 15–16 ☆ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited. ⁎ Corresponding author at: Suite 5, "
[Show abstract][Hide abstract] ABSTRACT: Compulsive gambling is recognized with Parkinson's disease treatment with dopamine agonists but has not been reported with antiepileptic medications (AEMs) in epilepsy. This is the first report regarding possible compulsive gambling, provoked by AEMs in a patient with idiopathic generalized epilepsy, who presented with nonconvulsive status epilepticus, having previously not achieved seizure control with carbamazepine, valproate, (VPA), topiramate, gabapentin (GPT), lamotrigine (LTG), and clobazam. Levetiracetam (LEV) was added to VPA and GPT, which the patient was already taking and LTG subsequently retrialed. Following the reintroduction of LTG, she lost $4000–5000, which she concealed. With better seizure control, VPA and GPT were withdrawn, leaving her on LEV and LTG. With increased LTG dosage, she lost $50,000, prompting discovery of her gambling.
Epilepsy and Behavior Case Reports 01/2014; 2(1):15–16. DOI:10.1016/j.ebcr.2013.11.002
"In a 4-week case series of eight patients with OCD who previously failed to respond to SSRIs, lamotrigine add-on at the maximum dose of 100 mg/day only benefited one patient (Kumar and Khanna, 2000). It should also be noted there have been case reports for lamotrigine potentially causing obsessive–compulsive symptoms, blepharospasm, and tourettism in a patient with major depression (Alkin et al., 2007), and, in two patients affected by bipolar II disorder, intrusive, repetitive phrases (Kemp et al., 2007), and obsessional symptoms (Kuloglu et al., 2008), respectively. More recently, an 8-week, open-label trial evaluated the efficacy and tolerability of lamotrigine in schizophrenia and schizoaffective patients with comorbid obsessive–compulsive symptoms (Poyurovsky et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: The present 16-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of patients with treatment-resistant obsessive-compulsive disorder (OCD) receiving serotonin reuptake inhibitors (SRIs). After clinical and neurocognitive assessments, patients were randomly allocated to receive, in a double-blind design, 100 mg/day of lamotrigine or a placebo. A final sample of 33 patients completed the study. The results obtained indicate that lamotrigine added to stable SRI treatment substantially improved obsessive-compulsive (Yale-Brown Obsessive Compulsive Scale: obsessions, p < 0.0001; compulsions, p < 0.0001; total score, p < 0.0001), and affective symptoms (Hamilton Rating Scale for Depression p < 0.0001). Regarding cognitive functions, improvement was observed only in Semantic Fluency (p = 0.004). The findings provide evidence that lamotrigine augmentation of SRI treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant OCD.
Journal of Psychopharmacology 02/2012; 26(11):1456-62. DOI:10.1177/0269881111431751 · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obsessive-compulsive disorder (OCD) is a disabling psychiatric condition affecting 1-2% of the community. Although modern drug, behavioral and psychosurgical therapies have improved the prognosis of OCD considerably, approximately 30% of patients remain treatment-refractory. Currently, selective serotonin (5-HT) reuptake inhibitors (SSRIs) are the drug treatments of choice for OCD. Accordingly, this review evaluates the evidence for a role of the serotonin (5-HT) neurochemical system in the treatment and pathophysiology of OCD. However, drug treatment approaches that modify function of interrelated neurochemical systems, such as the dopamine and glutamate systems, are also briefly discussed as they promise to complement and enhance SSRI treatment effects.
Drug Discovery Today 05/2008; 13(7-8):325-32. DOI:10.1016/j.drudis.2007.12.009 · 6.69 Impact Factor
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