Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression .
Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression .
Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials.
OBJECTIVES The efficacy of lamotrigine as maintenance treatment for bipolar disorder ( BD ) , particularly for delaying depressive episodes , is well established , but its efficacy in the acute treatment of bipolar depression is less clear . This paper reports the results of five r and omized , double-blind , placebo-controlled trials of lamotrigine monotherapy for the acute treatment of bipolar depression . METHODS Adult subjects with bipolar I or II disorder experiencing a depressive episode were r and omized to placebo or lamotrigine monotherapy ( after titration , at a fixed dose of 50 mg or 200 mg daily in Study 1 ; a flexible dose of 100 - 400 mg daily in Study 2 ; or a fixed dose of 200 mg daily in Studies 3 , 4 and 5 ) for 7 - 10 weeks . RESULTS Lamotrigine did not differ significantly from placebo on primary efficacy endpoints [ 17-item Hamilton Depression Rating Scale in Studies 1 and 2 ; Montgomery-Asberg Depression Rating Scale ( MADRS ) in Studies 3 , 4 and 5 ] . In Study 1 , lamotrigine significantly separated from placebo on some secondary measures of efficacy , including the MADRS , the Clinical Global Impressions-Severity ( CGI-S ) and the CGI-Improvement ( CGI-I ) , but seldom differed on secondary efficacy endpoints for the other studies . CONCLUSIONS Lamotrigine monotherapy did not demonstrate efficacy in the acute treatment of bipolar depression in four out of five placebo-controlled clinical studies . Lamotrigine was well tolerated in the acute treatment of bipolar depression
Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression .
Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression .