Lamotrigine for Bipolar Depression
from Doctor's Guide to Medical News at http://www.pslgroup.com/dg/EB8EA.htm
A recent issue of the Journal of Clinical Psychiatry reports that lamotrigine (Lamictal®, Glaxo Wellcome [Canada]) shows antidepressant activity in people with bipolar depression (the depressed phase of bipolar disorder, also known as manic depression) and that clinical improvement was evident as early as the third week of treatment of major depressive episodes. This 7-week study was the first randomised, double-blind, placebo-controlled trial to evaluate a single agent as a treatment for the depression component of bipolar disorder.
Conducted in 21 centres Australia, France, the UK and the USA, this study involved 195 people 18 years of age or older, diagnosed with bipolar I disorder, and currently experiencing a major depressive episode. No adjunctive mood stabilisers (lithium or valproic acid) were allowed during the study. Psychiatric evaluations, completed at the beginning of the study and at weekly intervals, indicated that the participants were moderately to markedly ill at the beginning of the study (90% had been treated previously for bipolar disorder; 50% had been hospitalized; 30% had attempted suicide).
Adverse reaction included nausea, rash, pain, dizziness and headache. Nine participants discontinued the trial due to rash, although none were considered serious or required hospitalization. There were no clinically significant changes in body weight, systolic or diastolic blood pressure, or pulse rate in any of the treatment groups during the course of the trial.
Bipolar disorder affects 1-2% of the population. Risk of incidence rises to about 15% among immediate relatives. The first episode is most often during young adulthood, but may occur at any time. In later years, it may be indicative of other medical problems, or result from drug, alcohol or steroid abuse. It is characterised by a combination of manic and depressive episodes, each sometimes lasting a week or longer, and often with long periods of normal mood. The severity and sequence of each episode varies from person to person.
The cause of bipolar disorder is unknown but is believed to be associated with an imbalance of neurotransmitters in the brain. Biological factors may play a role in its development, but specific genetic markers have yet to be found.
Misdiagnosis and delayed treatment are common. Only 10% of people with bipolar disorder seek help on their own, and then more likely for depressive episodes than for the manic phase. Untreated, bipolar disorder tends to worsen, with the severity of episodes of mania and/or depression increasing. The suicide rate among people with untreated bipolar disorder is 15% to 20%.
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