title: Sustained remission with lamotrigine augmentation or monotherapy in female resistant depressives with mixed cyclothymic-dysthymic temperament.
abstract: BACKGROUND
  The treatment of bipolar depression remains problematic. Lamotrigine has been shown in randomized controlled studies to be efficacious in preventing bipolar depression and rapid cycling states.
  
  
  METHODS
  Twenty-four women with cyclothymic temperament and refractory depression were recruited from four outpatient sites (three primary care and one psychiatric) and treated with lamotrigine in a naturalistic, open-label study. Temperament was determined by responses on the TEMP-A self-rating scale. Eighteen (75%) of these cyclothymic patients also scored high on the depressive temperament. Eighteen (75%) met DSM-IV criteria for bipolar II disorder. In two thirds of the cases, lamotrigine was add-on therapy to an antidepressant. Response to therapy was assessed using the DSM-IV Global Assessment of Functioning (GAF).
  
  
  CONCLUSIONS
  This study was naturalistic in design, without controls or blinds.
  
  
  RESULTS
  Of the 23 patients who remained in the study, 16 (70%) had significant, sustained responses. Of these 16, 12 (75% of responders, 52% of the total) had remissions (GAF > 80) sustained longer than 12 months. Robust, sustained responses to lamotrigine monotherapy were seen in 4 patients (17%). Seven patients (30%) received no apparent benefit from lamotrigine.
  
  
  CONCLUSIONS
  Lamotrigine induced prolonged illness remissions in a substantial number of female patients whose symptoms were both complex and refractory. Most manifested high scores on the cyclothymic and depressive temperaments, and prior refractoriness to multiple antidepressant and antidepressant/mood stabilizer combinations, before remitting with lamotrigine augmentation or monotherapy.
authors.affiliation: From Mood Clinic, Family Medicine Department, University of Tennessee, Memphis, TN, USA. smanning1@triad.rr.com
authors.forename: J Sloan
authors.initials: JS
authors.lastname: Manning
authors.forename: Radwan F
authors.initials: RF
authors.lastname: Haykal
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Connor
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Cunningham
authors.forename: W Clay
authors.initials: WC
authors.lastname: Jackson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Long
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003527:Cyclothymic Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077213:Lamotrigine; D008875:Middle Aged; D010555:Personality Inventory; D013694:Temperament; D014227:Triazines / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000928:Antidepressive Agents; D014227:Triazines; D000077213:Lamotrigine