Lamotrigine for maintenance treatment of bipolar disorders
Brief summary
Evidence from systematic reviews
What is the current evidence for the use of lamotrigine in the maintenance treatment of bipolar disorders?
Lamotrigine performs better than placebo in preventing all relapses. When compared to lithium, lamotrigine tended to prevent depressive episodes and lithium tended to prevent manic episodes. All trials were performed by the pharmaceutical industry.Is there any group of patients that respond better to lamotrigine than the others?
Primary studies included adult out-patients of both genders who tolerated lamotrigine well in an open label phase. Patients who had abused substances within the last 6 months or who were at serious risk of suicide were excluded.
Should lamotrigine be used as a single or combination treatment?
The trials compared lamotrigine as a single treatment to either placebo or lithium. When compared with placebo, patients taking lamotrigine tended to complain more of sedation, although adverse events were described in only one of the three primary studies. When compared with lithium, adverse events leading to discontinuation and fine tremor were less frequent on those taking lamotrigine.What are the adverse events at short and long term?
Trials used lamotrigine for 6 to 18 months. Adverse events included fine tremor, weight gain, motor disorders, or somnolence; and adverse events leading to treatment discontinuation.
For how long should lamotrigine (single or combination) be used?
Trials used lamotrigine for 6 to 18 months.
Is lamotrigine more efficacious than other mood stabilisers in the maintenance treatment of bipolar disorders?
In comparison with lithium, lamotrigine tended to prevent depressive episodes and lithium tended to prevent manic episodes, although the results were inconclusive and based on a limited amount of data.
Is the balance between harm and benefit favourable to the use of lamotrigine?
Lamotrigine is favourable to placebo. In comparison with lithium, lamotrigine is better at preventing depressive episodes.
What type of research (if any) is needed to clarify the benefits and harms of using lamotrigine in the treatment of acute mania?
Trials performed in heterogeneous populations (including those with substance abuse), regardless of risk of suicide, measuring relevant clinical outcomes, representing both benefit and harm. Trials should compare lamotrigine with other mood stabilisers and/or olanzapine.
