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Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Authors Watanabe Y, Hongo S

Received 24 November 2016

Accepted for publication 30 December 2016

Published 20 March 2017 Volume 2017:13 Pages 843—854


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Taro Kishi

Yoshinori Watanabe,1,2 Seiji Hongo2

1Himorogi Psychiatric Institute, Tokyo, 2Nanko Clinic of Psychiatry, Shirakawa city, Fukushima, Japan

Background: We investigated whether the long-term efficacy and safety of lamotrigine (LTG) for bipolar disorder (BP) differs between disease types (BP-I, BP-II, or BP not otherwise specified [BP-NOS]), and the efficacy of the concomitant use of antidepressants (ADs).
Methods: For >1 year, we observed 445 outpatients with BP (diagnosed by DSM-IV criteria) who initiated LTG treatment between July 1 and October 31, 2011, using the Himorogi Self-rating Depression (HSDS) and Anxiety Scales and the Clinical Global Impression-Improvement scale and also recorded adverse events.
Results: Treatment efficacy was observed at week 4, with the improved HSDS scores sustained until week 52 for all types of BP; 50% of the patients with any type of BP could be treated with LTG for 1 year, whereas ~40% could be treated for >1.5 years. However, 25% of the patients were withdrawn within the first 4 weeks. The overall incidence of adverse events was 22.9% (104/455): 34.1% (14/41) for BP-I, 22.7% (15/66) for BP-II, and 22.2% (75/338) for BP-NOS. The most common adverse event was skin rash: 22.0% for BP-I, 16.7% for BP-II, and 12.1% for BP-NOS.
Limitations: There was no control group. Data were collected retrospectively.
Conclusion: With careful and adequate titration, long-term treatment with LTG is possible for any type of BP, with BP-NOS patients, the largest population in clinical practice, responding particularly well. Symptoms can improve with or without ADs. Large-scale prospective studies of the efficacy of ADs in bipolar treatment are warranted.

Keywords: lamotrigine, bipolar disorder, long-term efficacy, antidepressant, skin rash, anxiety

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