Posted by SLS on March 12, 2001, at 16:18:08
In reply to Re: Lamictal+Clonazepam=HYPOMANIA?CamW/Sunnely? » SLS, posted by judy1 on March 12, 2001, at 10:30:17
Hi Judy,
The first of the following two abstracts was authored by some pretty impressive personages. This is one article that I wish I could get my hands on and give to a statistician to interpret the results independent of the conclusions offered. They seem pretty tentative about touting lamotrigine as a robust medication to treat rapid-cyclicity. The statistical result offered of 41% efficacy versus 26% placebo doesn't seem terribly impressive to me, although it might be considered such in light of the refractory nature of rapid-cycling presentations. I know this sounds silly and overly simplistic, and I'm sure that it is, but 41%-26%=14%. What? Only 14% better? I'm not sure that a (p = .036) is a terribly high level of confidence either. I'll let someone who really knows something in this area educate me. However, I don't suppose I would complain too much if I were to find myself in that 14% group.
If the mood-stabilizing efficacy of lamotrigine monotherapy is as mediocre to prevent mania as it is to prevent rapid-cyclicity, perhaps it is incapable of offsetting the manic pressure produced by the drug's antidepressant properties. The net effect from using lamotrigine would be the development of mania or rapid-cyclicity for some people. It is interesting that several papers I came across described the rate of switching to be "low" for lamotrigine. I gather, then, that it does happen, even under the scrutiny of unsuspecting, and perhaps skeptical observers.
For my part, 200mg lamotrigine failed to hamper in any way my shooting into a Nardil-discontinuation rebound mixed-mania. Too many people on the most current Psycho-Babble postings have described manic-type reactions to lamotrigine to ignore taking a closer look at it.
If I find something more concrete that you can show your medical team, I will let you know. Otherwise, you may want to simply try adding Neurontin.
You are frequently in my thoughts, Judy.
Take care.
- Scott
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5: J Clin Psychiatry 2000 Nov;61(11):841-50A double-blind, placebo-controlled, prophylaxis study of lamotrigine in
rapid-cycling bipolar disorder. Lamictal 614 Study Group.Calabrese JR, Suppes T, Bowden CL, Sachs GS, Swann AC, McElroy SL, Kusumakar V, Ascher JA, Earl NL, Greene PL, Monaghan ET
University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Ohio, USA.
BACKGROUND: Patients with rapid-cycling bipolar disorder are often treatment refractory. This study examined lamotrigine as maintenance monotherapy for rapid-cycling bipolar disorder. METHOD: Lamotrigine was added to patients' current psychotropic regimens and titrated to clinical effect during an open-label treatment phase. Stabilized patients were tapered off other psychotropics and randomly assigned to lamotrigine or placebo monotherapy for 6 months. Time to additional pharmacotherapy for emerging symptoms was the primary outcome measure. Secondary efficacy measures included survival in study (time to any premature discontinuation), percentage of patients stable without relapse for 6 months, and changes in the Global Assessment Scale and Clinical Global Impressions-Severity scale. Safety was assessed from adverse event, physical examination, and laboratory data. RESULTS: 324 patients with rapid-cycling bipolar disorder (DSM-IV criteria) received open-label lamotrigine, and 182 patients were randomly assigned to the double-blind maintenance phase. The difference between the treatment groups in time to additional pharmacotherapy did not achieve statistical significance in the overall efficacy population. However, survival in study was statistically different between the treatment groups (p = .036). Analyses also indicated a 6-week difference in median survival time favoring lamotrigine. Forty-one percent of lamotrigine patients versus 26% of placebo patients (p = .03) were stable without relapse for 6 months of monotherapy. Lamotrigine was well tolerated; there were no treatment-related changes in laboratory parameters, vital signs, or body weight. No serious rashes occurred. CONCLUSION: This was the largest and only prospective placebo-controlled study of rapid-cycling bipolar disorder patients to date; results indicate lamotrigine monotherapy is a useful treatment for some patients with rapid-cycling bipolar disorder.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trialPMID: 11105737
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30: Ann Pharmacother 1999 Jul-Aug;33(7-8):864-7Lamotrigine--an effective mood stabilizer?
Maidment ID
Hellesdon Hospital, Norwich, Norfolk, United Kingdom.
OBJECTIVE: To review the literature regarding the use of lamotrigine as a mood stabilizer, and to discuss its efficacy in treating this condition. DATA SOURCES: Data were obtained from MEDLINE, Micromedex, and Cochrane collaboration searches from January 1985 to July 1998. DATA SUMMARY: There are insufficient data to confirm that lamotrigine is an effective mood stabilizer. There are no controlled studies, and the current evidence is from case studies and open trials. Furthermore, only one study shows any evidence of effectiveness in the manic phase, although this may be because the data tend to relate to a treatment-refractory population. CONCLUSIONS: From the current evidence, lamotrigine cannot be recommended as a mood stabilizer except when conventional therapies have failed.
Publication Types: Review Review, tutorial
PMID: 10466917
poster:SLS
thread:56140
URL: http://www.dr-bob.org/babble/20010310/msgs/56303.html