title: Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report.
abstract: OBJECTIVE
  To evaluate lamotrigine in a woman with a 30-year history of treatment-resistant menstrually-entrained rapid cycling bipolar II disorder with follicular phase depressive and luteal phase mood elevation symptoms.
  
  
  METHODS
  Lamotrigine was started at 5 mg/day and gradually increased up to 300 mg/day, while venlafaxine was tapered gradually and discontinued, and divalproex sodium 500 mg/day and levothyroxine 175 mcgm/day were continued. Daily self-reported mood ratings were obtained from the patient, using ChronoRecord software.
  
  
  RESULTS
  As lamotrigine was increased gradually, mood cycle amplitude attenuated. There was notable decrease in the severity and duration of depressive symptoms specifically during the follicular phase of the menstrual cycle. At the time of submission of this paper, the subject had remained euthymic for a total of 12 months.
  
  
  CONCLUSIONS
  This case suggests the potential utility of lamotrigine in treatment-resistant menstrually-related rapid cycling bipolar disorder, and raises the possibility that lamotrigine might be able to treat pathological entrainment of mood with the menstrual cycle. Both of these issues merit systematic assessment.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
authors.forename: O V
authors.initials: OV
authors.lastname: Becker
authors.forename: N L
authors.initials: NL
authors.lastname: Rasgon
authors.forename: W K
authors.initials: WK
authors.lastname: Marsh
authors.forename: T
authors.initials: T
authors.lastname: Glenn
authors.forename: T A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D002909:Chronobiology Phenomena / Q000502:physiology; D003511:Cyclohexanols / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D005498:Follicular Phase / Q000523:psychology; D006801:Humans; D000077213:Lamotrigine; D008598:Menstruation / Q000523:psychology*; D013974:Thyroxine / Q000627:therapeutic use; D014227:Triazines / Q000008:administration & dosage / Q000627:therapeutic use*; D014635:Valproic Acid / Q000627:therapeutic use; D000069470:Venlafaxine Hydrochloride
chemical_list: D018692:Antimanic Agents; D003511:Cyclohexanols; D014227:Triazines; D014635:Valproic Acid; D000069470:Venlafaxine Hydrochloride; D013974:Thyroxine; D000077213:Lamotrigine