Newer Anticonvulsants
Key points
- Because many patients with bipolar disorder have a less than satisfactory response to available medication treatments, clinicians will often begin to experiment with new medications before they have been carefully studied in controlled trials.
- This is the case for several new anticonvulsants, most notably lamotrigine and gabapentin.
- Despite extremely limited short- or long-term efficacy data on these agents, their use for the treatment of bipolar disorder and refractory depression is widespread.
- Lamotrigine is the best studied of the newer anticonvulsants.
Antidepressant and Antimanic Medications: Newer Anticonvulsants
Because many patients with bipolar disorder have a less than satisfactory response to available medication treatments, clinicians will often begin to experiment with new medications before they have been carefully studied in controlled trials. This is the case for several new anticonvulsants, most notably lamotrigine and gabapentin. Despite extremely limited short- or long-term efficacy data on these agents, their use for the treatment of bipolar disorder and refractory depression is widespread.
Lamotrigine is the best studied of the newer anticonvulsants. Along with many open-label studies, there is one large multisite placebo-controlled trial of lamotrigine monotherapy for treatment of depression in outpatients with bipolar disorder. In this study, 200 mg/day of lamotrigine demonstrated significant antidepressant effects in over 50% of these patients without inducing mania or rash. Lamotrigine inhibits voltage-gated sodium channels and reduces glutamate. It is absorbed within 1-3 hours and has a half-life of 25 hours. Rash can occur in up to 8% of adults, and serious rash requiring hospitalization can be seen in up to 0.5% of patients. Because of the possibility of Stevens-Johnson syndrome, toxic epidermal necrolysis, or angioedema, all rashes should be regarded as potentially serious and monitored closely. Starting with low dosages (25 mg/day) and titrating dosages slowly may help reduce the occurrence of rash. Lamotrigine may be more effective in treating depression in bipolar disorder than in treating mania. Studies are under way to investigate the efficacy of lamotrigine for the treatment of depression in unipolar mood disorders.
Antidepressant and Antimanic Medications Introduction Diagnostic Indications and Contraindications
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
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