Lack of Mania Prophylaxis Associated With Lamotrigine Monotherapy in Manic-Predominant Bipolar I Disorder

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Sir: Unlike all other mood-stabilizing drugs, lamotrigine does not have an indication for acute mania. The maintenance indication for lamotrigine is based on two 18-month studies evaluating time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in bipolar I patients treated for acute mood episodes with standard therapy. Only when these 2 studies were analyzed together (a priori determined to increase statistical power) was the superiority of lamotrigine over placebo in delaying the time to intervention for a manic episode evident.1

J Clin Psychiatry 2007;68(6):973-974