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The role of lamotrigine in the management of bipolar disorder

Authors Felicity Ng, Karen Hallam, Nellie Lucas, Michael Berk

Published 15 September 2007 Volume 2007:3(4) Pages 463—474



Felicity Ng1, Karen Hallam2, Nellie Lucas3, Michael Berk1

1Department of Clinical and Biomedical Sciences: Barwon Health, University of Melbourne, Geelong, Victoria, Australia; 2Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; 3ORYGEN Research Centre, Melbourne, Victoria, Australia

Abstract: Lamotrigine has emerged with a distinct place in the pharmacological treatment of bipolar disorder, with the potential to treat and prevent bipolar depression, which is the dominant and arguably most disabling and under-treated phase of the illness. This review examines the published clinical trials of lamotrigine in bipolar treatment. While the data supports its tolerability and safety, the strongest evidence for its efficacy lies in the prevention of bipolar depression, with weaker evidence for the treatment of acute bipolar depression, refractory unipolar and bipolar depression, and rapid cycling bipolar disorder. The total number of published well designed trials is small, even the maintenance evidence is derived from two studies. However, this relative inadequacy compares favorably with the alternative treatment options for bipolar depression, which are marked by poor efficacy or risk of polarity switch. The designation of lamotrigine as first-line treatment for bipolar depression prophylaxis should be done in cognizance of this context, and it would seem prudent to await greater evidence of efficacy before designating lamotrigine as first-line treatment for other bipolar indications. Further randomized controlled trials are required to consolidate the available findings and to explore the boundaries of lamotrigine’s efficacy, which may encompass the soft spectral disorders.

Keywords: Lamotrigine, bipolar disorder, bipolar depression, clinical trials, efficacy