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 .
Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial.
OBJECTIVE Lamotrigine is one of the pharmacologic options for the treatment of bipolar depression but has only been studied as monotherapy . This study compared the acute effects of lamotrigine and placebo as add-on therapy to ongoing treatment with lithium in patients with bipolar depression . METHOD Out patients ( N = 124 ) aged 18 years and older with a DSM-IV bipolar I or II disorder and a major depressive episode ( Montgomery-Asberg Depression Rating Scale [ MADRS ] score > or = 18 and Clinical Global Impressions-Bipolar Version [ CGI-BP ] severity of depression score > or = 4 ) while receiving lithium treatment ( 0.6 - 1.2 mmol/L ) were r and omly assigned to 8 weeks of double-blind treatment with lamotrigine ( titrated to 200 mg/d ) or placebo . The primary outcome measure was mean change from baseline in total score on the MADRS at week 8 . Secondary outcome measures were response ( defined as a reduction of > or = 50 % on the MADRS and /or change of depression score on the CGI-BP of " much improved " or " very much improved " compared to baseline ) and switch to mania or hypomania ( defined as a CGI-BP severity of mania score of at least mildly ill at any visit ) . Patients were included in the study between August 2002 ( Spain started in October 2003 ) and May 2005 . RESULTS Endpoint mean change from baseline MADRS total score was -15.38 ( SE = 1.32 ) points for lamotrigine and -11.03 ( SE = 1.36 ) points for placebo ( t = -2.29 , df = 104 , p = .024 ) . Significantly more patients responded to lamotrigine than to placebo on the MADRS ( 51.6 % vs. 31.7 % , p = .030 ) , but not on the CGI-BP change of depression ( 64.1 % vs. 49.2 % , p = .105 ) . Switch to mania or hypomania occurred in 5 patients ( 7.8 % ) receiving lamotrigine and 2 patients ( 3.3 % ) receiving placebo ( p = .441 ) . CONCLUSION Lamotrigine was found effective and safe as add-on treatment to lithium in the acute treatment of bipolar depression . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00224510
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 .