Ng, Felicity, Hallam, Karen, Lucas, Nellie and Berk, Michael (2007) The Role of Lamotrigine in the Management of Bipolar Disorders. Neuropsychiatric Disease and Treatment, 3 (4). pp. 463-474. ISSN 1176-6328

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 effi cacy 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 fi rst-line treatment for bipolar depression prophylaxis should be done in cognizance of this context, and it would seem prudent to await greater evidence of effi cacy before designating lamotrigine as fi rst-line treatment for other bipolar indications. Further randomized controlled trials are required to consolidate the available fi ndings and to explore the boundaries of lamotrigine’s efficacy, which may encompass the soft spectral disorders.

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