Lamotrigine as add-on treatment to lithium and divalproex: lessons learned from a double-blind, placebo-controlled trial in rapid-cycling bipolar disorder.
Lamotrigine as add-on treatment to lithium and divalproex: lessons learned from a double-blind, placebo-controlled trial in rapid-cycling bipolar disorder.
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DOI：
10.1111/bdi.12013
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发表时间：
2012-11
影响因子：
5.4
通讯作者：
Calabrese JR
中科院分区：
文献类型：
--
作者：
Kemp DE;Gao K;Fein EB;Chan PK;Conroy C;Obral S;Ganocy SJ;Calabrese JR
A substantial portion of the morbidity associated with rapid-cycling bipolar disorder (RCBD) stems from refractory depression. This study assessed the antidepressant effects of lamotrigine as compared with placebo when used as add-on therapy for rapid-cycling bipolar depression non-responsive to the combination of lithium plus divalproex. During Phase 1 of this trial, hypomanic, manic, mixed, and/or depressed outpatients (n = 133) aged 18–65 with DSM-IV RCBD type I or II were initially treated with the open combination of lithium and divalproex for up to 16 weeks. During Phase 2, subjects who did not meet the criteria for stabilization (n = 49) (i.e., remained or cycled into the depressed phase) were randomly assigned to double-blind, adjunctive lamotrigine (n = 23) or adjunctive placebo (n = 26). The primary endpoint was the mean change in depression symptom severity from the beginning of Phase 2 to the end of Phase 2 (week 12) on the Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Data were analyzed by analysis of covariance with last observation carried forward and a mixed-models analysis. During Phase 1, a high rate of study discontinuations occurred due to intolerable side effects (13/133; 10%) and study non-adherence (22/133; 17%). Only 14% (19/133) stabilized on the open combination of lithium and divalproex. Among the 49 (37%) patients randomized to the double-blind adjunctive treatment phase, mean ± standard error change from baseline on the MADRS total score was −8.5 ± 1.7 points for lamotrigine and −9.1 ± 1.5 points for placebo (p = NS; mixed-models analysis). No significant differences were observed in the rates of response, remission, or bimodal response between lamotrigine and placebo. The poor tolerability, lack of efficacy, and high rate of early discontinuation with the combination of lithium and divalproex suggests this regimen was ineffective for the majority of patients with RCBD. Among patients who did not stabilize on lithium and divalproex, the addition of lamotrigine was no more effective than placebo in reducing depression severity. The findings suggest an opportunity for several design modifications to enhance signal detection in future trials of RCBD. The main limitation is the small number of subjects randomized to double-blind treatment.
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影响因子：
3.3
作者：
Leon, Andrew C.;Davis, Lori L.
通讯作者：
Davis, Lori L.
影响因子：
5.3
作者：
Kupka, RW;Luckenbaugh, DA;Nolen, WA
通讯作者：
Nolen, WA
影响因子：
5.3
作者：
McElroy, Susan L.;Weisler, Richard H.;Young, Allan H.
通讯作者：
Young, Allan H.
DOI：
10.4088/jcp.08m04301
发表时间：
2009-02
期刊：
The Journal of clinical psychiatry
影响因子：
--
作者：
Goldberg JF;Brooks JO 3rd;Kurita K;Hoblyn JC;Ghaemi SN;Perlis RH;Miklowitz DJ;Ketter TA;Sachs GS;Thase ME
通讯作者：
Thase ME
影响因子：
--
作者：
Bowden, CL;Calabrese, JR;DeVeaugh-Geiss, J
通讯作者：
DeVeaugh-Geiss, J