Lamotrigine as an Augmentation Agent in Treatment-Resistant Depression
J Clin Psychiatry 2002;63(8):737-741
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The anticonvulsant
lamotrigine has been reported to be efficacious and well
tolerated as monotherapy in the treatment of
bipolar patients as well as in treatment-refractory
bipolar disorder. However, there is a paucity of
research on the use of lamotrigine as an
augmentation agent in treatment-refractory unipolar major
Method: This study was a retrospective
chart review on the efficacy of lamotrigine
augmentation in 37 individuals diagnosed with chronic
or recurrent major depressive disorder (DSM-IV) who had failed to respond adequately to at least
2 previous trials of antidepressants. Thirty-one
patients who were on lamotrigine treatment for at least 6 weeks (6 discontinued prematurely due
to adverse events) took a mean dose of 112.90 mg/day for a mean of 41.80 weeks. The primary
efficacy parameter for this study was the Clinical Global Impressions scale, which was
retrospectively applied. In addition, these data
were supplemented by an analysis of prospectively rated Global Assessment of Functioning scores.
Results: On the basis of intent-to-treat
analysis, response rates were as follows: 40.5%
(15/37) much improved or very much improved, 21.6% (8/37) mildly improved, and 37.8% (14/37)
unchanged. The percentage of patients who were rated much or very much improved and
completed 6 weeks on the drug was 48.4% (15/31). No differences were found in the doses of
lamotrigine given to responders and nonresponders.
Conclusion: Analyses revealed that
lamotrigine treatment was most effective for
patients who had been depressed for shorter periods
of time and had failed fewer previous trials of
antidepressants. Data also suggested a trend
toward increased response for patients with
comorbid anxiety disorders and/or chronic pain syndromes.