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Lamotrigine update and its use in mood disorders
1College of Pharmacy, Idaho State University, Pocatello, ID, USA. hurley@otc.isu.edu
The Annals of Pharmacotherapy
|April 30, 2002
Summary
Lamotrigine is an anticonvulsant effective for bipolar disorder but not major depression. Due to its cost and potential for severe rash, it is best used as a second-line treatment for bipolar depression.
Area of Science:
- Pharmacology and Therapeutics
- Neuroscience
- Psychiatry
Background:
- Lamotrigine is an anticonvulsant medication.
- Mood disorders, including bipolar disorder and major depression, represent significant public health challenges.
- Understanding the therapeutic profile of medications like lamotrigine is crucial for effective treatment.
Purpose of the Study:
- To systematically review the pharmacology, pharmacokinetics, efficacy, adverse effects, and cost of lamotrigine.
- To provide an updated assessment of lamotrigine's role in managing mood disorders.
Main Methods:
- Systematic literature search of MEDLINE (1985-September 2001) and other sources.
- Inclusion of English-language articles and conference abstracts.
- Tabulation of data from 20 clinical trials on mood disorder response rates.
Main Results:
- Lamotrigine modulates voltage-gated sodium channels, reducing glutamate transmission and calcium influx.
- Pooled response rates for bipolar disorder (depressed, manic, mixed, rapid cycling) ranged from 52% to 63%.
- Adverse effects, including rash, are more common with combination therapy; serious rash occurs in ~1 in 500 patients. Lamotrigine is more expensive than lithium, carbamazepine, and valproic acid.
Conclusions:
- Lamotrigine demonstrates efficacy in bipolar disorder but lacks sufficient data for major depression.
- A slow dose titration is recommended to mitigate the risk of severe rash.
- Considering efficacy, adverse effects, and cost, lamotrigine is best reserved as a second-line agent for bipolar depression.