Lamotrigine in Acute Bipolar Depression: Two Thumbs Up-or One?

I just read and enjoyed “Treatment-Resistant Bipolar Disorder”¹ at www.PsychiatricTimes.com, and wanted to thank the author for pulling together a great deal of useful information in a succinct and lucid format.

There are, of course, many areas of controversy in the literature, and one of those concerns the utility of lamotrigine in acute bipolar depression. Would Dr Chou comment on the “++” rating for lamotrigine in acute bipolar depression in the Table that accompanied that article? I believe that Nassir Ghaemi, MD, MPH, has expressed considerable skepticism that the claim is supported by placebo-controlled studies. His views can be found at: http://www.medscape.com/viewarticle/579046.

My impression, too, is that there is no convincing randomized, placebo-controlled evidence for lamotrigine in the acute phase of bipolar depression (although it may be useful as a maintenance agent).
 

Ronald Pies, MD
Editor in Chief

Psychiatric Times

Dr Chou Responds:

Thank you for the input, which is much appreciated. I understand the skepticism, especially given the single positive study and the several negative/failed studies. On the basis of only placebo-controlled studies, I would agree with changing the “++” to a single “+.” The revised Table  reflects this change for lamotrigine in acute bipolar depression.

If you want to consider the numerous recommendations from practice guidelines as well as clinical experience/
expert recommendations (including my own), I would keep the “++,” but obviously, this is not the spirit of the remainder of the review.

James C-Y Chou, MD, DFAPA, ACPsych

References:

Reference

1. Chou J C-Y. Treatment-resistant bipolar disorder. Psychiatric Times.http://www.psychiatrictimes.com/display/article/10168/1430568?pageNumber=1. Accessed August 17, 2009.