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Lamotrigine versus lithium augmentation of antidepressant therapy in treatment-resistant depression: efficacy and tolerability.
Psychiatr Danub. 2009 Jun; 21(2):187-93.PD

Abstract

BACKGROUND

Mood stabilizer augmentation of standard antidepressant drugs has been shown to be effective in treatment-resistant depression. Despite the reported high overall efficacy, lithium has been relatively underused in recent years. Lamotrigine, a novel anticonvulsant recently recognized as a mood stabilizer, seems to have putative antidepressive properties. The aim of the study was to investigate lamotrigine efficacy and tolerability as antidepressant augmentation for unipolar treatment-resistant depression compared to lithium.

SUBJECTS AND METHODS

88 patients suffering from treatment-resistant Major depressive disorder, having acute recurrent depressive episodes according to DSM-IV criteria, were enrolled in the study. This was an open-label trial with a flexible dosing regimen. All patients, received antidepressants in full therapeutic doses. They were divided into two augmentation groups: 46 patients received 50-200 mg/day lamotrigine, and 42 patients received 600-1200 mg/day lithium. The Hamilton Rating Scale for Depression (HAM-D) and The Clinical Global Impression scale (CGI) were used to monitor therapeutic efficacy. Patients were evaluated weekly for an 8 week treatment period.

RESULTS

The HAM-D total score was significantly reduced in both treatment groups at the study endpoint, without any difference between the groups. However, significant clinical improvement was reached within the second treatment week in the lamotrigine group compared to the lithium group (p=0.01 vs. lithium). Lamotrigine showed significant efficacy on the HAM-D item 1(depressed mood; p=0.01), item 7 (work and interest; p=0.01) and CGI-Improvement scale (p=0.02). The drop-out rate due to treatment failure was lower in the lamotrigine group (n=1) compared to the lithium (n=4) group. Also, the incidence of side effects did not differ between the groups.

CONCLUSIONS

Our results suggest that lamotrigine could be useful as augmentation of antidepressants for treatment-resistant unipolar depression. Also, lamotrigine may accelerate the onset of antidepressant action, and therefore might be useful in treatment of major depression in general.

Authors+Show Affiliations

Institute for psychiatry, Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia. majaiv@Eunet.rsNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19556947

Citation

Ivković, Maja, et al. "Lamotrigine Versus Lithium Augmentation of Antidepressant Therapy in Treatment-resistant Depression: Efficacy and Tolerability." Psychiatria Danubina, vol. 21, no. 2, 2009, pp. 187-93.
Ivković M, Damjanović A, Jovanović A, et al. Lamotrigine versus lithium augmentation of antidepressant therapy in treatment-resistant depression: efficacy and tolerability. Psychiatr Danub. 2009;21(2):187-93.
Ivković, M., Damjanović, A., Jovanović, A., Cvetić, T., & Jasović-Gasić, M. (2009). Lamotrigine versus lithium augmentation of antidepressant therapy in treatment-resistant depression: efficacy and tolerability. Psychiatria Danubina, 21(2), 187-93.
Ivković M, et al. Lamotrigine Versus Lithium Augmentation of Antidepressant Therapy in Treatment-resistant Depression: Efficacy and Tolerability. Psychiatr Danub. 2009;21(2):187-93. PubMed PMID: 19556947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lamotrigine versus lithium augmentation of antidepressant therapy in treatment-resistant depression: efficacy and tolerability. AU - Ivković,Maja, AU - Damjanović,Aleksandar, AU - Jovanović,Aleksandar, AU - Cvetić,Tijana, AU - Jasović-Gasić,Miroslava, PY - 2009/6/27/entrez PY - 2009/6/27/pubmed PY - 2009/8/22/medline SP - 187 EP - 93 JF - Psychiatria Danubina JO - Psychiatr Danub VL - 21 IS - 2 N2 - BACKGROUND: Mood stabilizer augmentation of standard antidepressant drugs has been shown to be effective in treatment-resistant depression. Despite the reported high overall efficacy, lithium has been relatively underused in recent years. Lamotrigine, a novel anticonvulsant recently recognized as a mood stabilizer, seems to have putative antidepressive properties. The aim of the study was to investigate lamotrigine efficacy and tolerability as antidepressant augmentation for unipolar treatment-resistant depression compared to lithium. SUBJECTS AND METHODS: 88 patients suffering from treatment-resistant Major depressive disorder, having acute recurrent depressive episodes according to DSM-IV criteria, were enrolled in the study. This was an open-label trial with a flexible dosing regimen. All patients, received antidepressants in full therapeutic doses. They were divided into two augmentation groups: 46 patients received 50-200 mg/day lamotrigine, and 42 patients received 600-1200 mg/day lithium. The Hamilton Rating Scale for Depression (HAM-D) and The Clinical Global Impression scale (CGI) were used to monitor therapeutic efficacy. Patients were evaluated weekly for an 8 week treatment period. RESULTS: The HAM-D total score was significantly reduced in both treatment groups at the study endpoint, without any difference between the groups. However, significant clinical improvement was reached within the second treatment week in the lamotrigine group compared to the lithium group (p=0.01 vs. lithium). Lamotrigine showed significant efficacy on the HAM-D item 1(depressed mood; p=0.01), item 7 (work and interest; p=0.01) and CGI-Improvement scale (p=0.02). The drop-out rate due to treatment failure was lower in the lamotrigine group (n=1) compared to the lithium (n=4) group. Also, the incidence of side effects did not differ between the groups. CONCLUSIONS: Our results suggest that lamotrigine could be useful as augmentation of antidepressants for treatment-resistant unipolar depression. Also, lamotrigine may accelerate the onset of antidepressant action, and therefore might be useful in treatment of major depression in general. SN - 0353-5053 UR - https://www.unboundmedicine.com/medline/citation/19556947/Lamotrigine_versus_lithium_augmentation_of_antidepressant_therapy_in_treatment_resistant_depression:_efficacy_and_tolerability_ L2 - http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol21_no2/dnb_vol21_no2_187.pdf DB - PRIME DP - Unbound Medicine ER -