An association of intrusive, repetitive phase with lamotrigine treatment in bipolar II disorder

Bipolar Disorder Research Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
CNS spectrums (Impact Factor: 2.71). 03/2007; 12(2):106-11.
Source: PubMed


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.

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    • "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 [6] 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, "
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    • "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). "
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