New analysis suggests lamotrigine might be a viable possibility in treating acute bipolar depression.
A workforce, led by Evyn M. Peters, Division of Psychiatry, College of Saskatchewan, analyzed the efficacy of lamotrigine in comparison with placebo for the remedy of acute bipolar melancholy and decided if sure melancholy scale gadgets had been extra conscious of lamotrigine remedy.
Whereas lamotrigine has generally been used to deal with bipolar melancholy, there’s not constant proof displaying the efficacy of the remedy.
Inconsistent Earlier Analysis
Within the research, the researchers carried out an item-level evaluation of pooled knowledge from 5 randomized placebo-controlled trials testing the remedy in 1072 sufferers with acute bipolar melancholy. Every affected person was handled for 7-10 weeks.
The goal dose of lamotrigine is 200 mg per day, with increased doses generally required in medical apply.
In 4 of the 5 trials, sufferers had been handled with 200 mg per day as the utmost dose.
The researchers defined why they thought earlier trials yielded inconsistent outcomes.
“Suboptimal dosing may clarify the damaging outcomes from the monotherapy trials,” the authors wrote. “One other potential clarification for the inconsistent findings is that lamotrigine could also be simpler for particular depressive signs that weren’t intentionally assessed within the authentic trials.”
The trials, whereas inconsistent, led to the approval of the remedy as a upkeep remedy in bipolar dysfunction, however not as an acute melancholy remedy.
The researchers measured depressive signs with the Hamilton Melancholy Ranking Scale and the Montgomery-Asberg Melancholy Ranking Scale.
“Counting on complete melancholy scale sum scores over focused assessments of core depressive signs could have impeded sign detection within the authentic trials,” the authors wrote.
The workforce additionally in contrast change scores on particular person scale gadgets between the totally different remedy teams.
The research resulted in statistically vital results on gadgets assessing depressed temper/disappointment, lack of curiosity/anhedonia, pessimism/guilt, and anergia/fatigue on each scales.
Nevertheless, they discovered marked variation within the baseline symptom prevalence, in addition to gadgets with increased scores at baseline typically had bigger and statistically vital remedy results.
“The outcomes urged a big remedy impact on core signs of melancholy,” the authors wrote. “A flooring impact appeared to restrict the sensitivity of different scale gadgets. Given the exploratory nature of the evaluation, agency conclusions can’t be drawn, though the outcomes had been according to previous analysis.”
Nevertheless, the researchers stated the research ought to be duplicated with a purpose to affirm the speculation.
“Given the exploratory nature of the evaluation, the outcomes have to be thought-about hypothesis-generating till replicated with extra knowledge,” the authors wrote. “Moreover, the outcomes could not generalize to broader medical populations, and solely clinician-rated symptom scales had been used to measure efficacy.”
The researchers additionally didn’t take a look at for interactions with different variables together with age and intercourse. Lastly, the usage of single gadgets to evaluate signs is one other limitation, though it does allow comparability with a big variety of industry-sponsored trials.
The research, “Lamotrigine for acute bipolar depression: An exploratory item-level analysis,” was printed on-line in Mind and Habits.