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Long-Term Treatment of Bipolar Disorder With Lamotrigine

Joseph R. Calabrese, MD; Melvin D. Shelton, MD, PhD; Daniel J. Rapport, MD; Susan E. Kimmel, MD; and Omar Elhaj, MD

Published: October 1, 2002

Article Abstract

Bipolar depression is as debilitating as mania in bipolar disorder, but the treatment of bipolar depressionhas historically received less attention. To date, there is no mood stabilizer (liberally definedas a medication that decreases episode severity, duration, or frequency in one phase of bipolar illnesswithout producing a negative effect in other phases) that demonstrates similar efficacy in both the depressiveand the manic phases of bipolar disorder. However, bipolar depression—which is prevalent,sometimes chronic, and associated with a low quality of life and a high risk of suicide—must be addressedas energetically as mania. Recent research into the long-term treatment of bipolar disorder hasraised several questions about the generalizability of early lithium studies, as a result of these studies’ designs. Researchers conducting more recent studies of mood stabilizers in the long-term treatment ofbipolar disorder have attempted to clarify their results by, for example, performing survival analysesof the data. Until pharmacotherapy has been found that is equally efficacious in the treatment of bothmanic and depressive episodes in bipolar disorder, the use of combination therapy to manage bipolardisorder is advised. Lithium and divalproex sodium remain the first-line treatments for mania. Lamotriginehas been found to have acute efficacy in treating episodes of bipolar depression without increasingcycling or provoking a switch into mania, as well as a long-term role in delaying relapse andrecurrence of depressive episodes.

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