Lamotrigine in Patients With Bipolar Disorder and Cocaine Dependence
J Clin Psychiatry 2003;64(2):197-201
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Bipolar disorder is associated with
the highest substance abuse rates of any psychiatric illness.
Therefore, treatments that stabilize mood and decrease drug use
or cravings are of great interest. Open-label lamotrigine was
examined in 30 outpatients with DSM-IV bipolar disorder and
cocaine dependence. Lamotrigine was either added to existing
medication regimens or used as monotherapy.
Method: Lamotrigine was started at a dose of 25
mg/day (12.5 mg/day in those taking valproic acid) and titrated
to a maximum dose of 300 mg/day. Subjects received a baseline
evaluation including a structured clinical interview and weekly
assessments for 12 weeks with the Hamilton Rating Scale for
Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief
Psychiatric Rating Scale (BPRS), and Cocaine Craving
Questionnaire (CCQ). At each appointment, a urine sample was
obtained, and participants reported drug use during the previous
week. The subjects consisted of 13 men and 17 women with cocaine
dependence and bipolar I disorder (N = 22), bipolar II disorder
(N = 7), or bipolar disorder not otherwise specified (N = 1),
with a mean ± SD age of 35.4 ± 7.2 years. Data were analyzed
using the last observation carried forward on all subjects who
completed the baseline evaluation and at least 1 postbaseline
Results: Significant improvement was observed in
HAM-D, YMRS, and BPRS scores (p < = .02). Cravings also
significantly decreased as measured by the CCQ (p < .001).
Dollar amount spent on drugs decreased nonsignificantly.
Lamotrigine was well tolerated, with no subjects discontinuing
due to side effects.
Conclusion: Lamotrigine treatment was well
tolerated in this sample and associated with statistically
significant improvement in mood and drug cravings but not drug
use. The findings suggest that larger controlled trials of
lamotrigine are needed in this population.