Lamotrigine for the treatment of bipolar disorder: A clinical case series

Background: Recently, a number of new agents have become available to treat bipolar disorder, however many patients may not respond fully even when used in combination. Early reports in epilepsy studies suggested mood- related effects of lamotrigine treatment, as have preliminary reports in bipolar patients. Methods: Seventeen patients meeting DSM-IV criteria for bipolar I (n = 9) or bipolar II (n = 8) disorder displaying affective symptoms and a past history of inadequate response or tolerability to at least two standard mood stabilizing agents were recruited through the Stanley Foundation Bipolar Network and treated with the new anticonvulsant lamotrigine in an add-on, open-label study. Response to therapy was assessed using the Clinical Global Impression Scale modified for bipolar disorder. Results: The mean dose of lamotrigine was 187±157 mg/day (range 50-600 mg/day) for a mean duration of 159±109 days (range 14-455 days). Eleven (65%) patients were rated as very much or much improved. Lamotrigine was well tolerated, and may have mood stabilizing and antidepressant properties in some patients with bipolar disorder. Limitations: The study is hypothesis generating because it was uncontrolled and open. Controlled studies are warranted. Conclusions: This preliminary report supports clinical improvement for both mood cycling and depression in patients with bipolar disorder treated with lamotrigine.