title: Maintenance treatment outcomes in older patients with bipolar I disorder.
abstract: OBJECTIVE
  The efficacy and tolerability of mood stabilizers in older adults with bipolar disorder remains understudied. Authors retrospectively examined response to lamotrigine, lithium, and placebo in older (>or=age 55) adults with Bipolar I disorder (DSM-IV) who participated in two mixed-age, maintenance studies examining time to intervention for an emerging mood episode (manic/hypomanic/mixed or depressed) and drug tolerability.
  
  
  METHODS
  In all, 588 patients received double-blind lamotrigine (LTG, 100 mg-400 mg/day), lithium (Li, 0.8 mEq/L-1.1 mEq/L), or placebo (PBO); data from 98 older adults (LTG: 33, Li: 34, PBO: 31) were examined. Mean modal total daily doses were LTG 240 mg and Li 750 mg.
  
  
  RESULTS
  LTG significantly delayed time to intervention for any mood episode and for a depressive episode, compared with placebo. Li significantly delayed time to intervention for mania/hypomania/mixed compared with placebo. Back pain and headache were the most common adverse events during LTG treatment; rash: LTG, 3%; Li, 6%; and PBO, 0; no serious rash was reported. The most common adverse events (>10%) during lithium treatment were dyspraxia, tremor, xerostomia, headache, infection, amnesia, dizziness, diarrhea, nausea, and fatigue.
  
  
  CONCLUSIONS
  Lamotrigine and lithium may be effective and well-tolerated maintenance therapies for older adults with Bipolar I depression.
authors.affiliation: Department of Psychiatry, Case University School of Medicine and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA. martha.sajatovic@uhhs.com
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Laszlo
authors.initials: L
authors.lastname: Gyulai
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Thompson
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Wilson
authors.forename: Robin
authors.initials: R
authors.lastname: White
authors.forename: Gary
authors.initials: G
authors.lastname: Evoniuk
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001416:Back Pain / Q000139:chemically induced; D001714:Bipolar Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods; D004361:Drug Tolerance; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D000077213:Lamotrigine; D016651:Lithium Carbonate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014150:Antipsychotic Agents; D014227:Triazines; D016651:Lithium Carbonate; D000077213:Lamotrigine