Maintenance treatment outcomes in older patients with bipolar I disorder.
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.
Sajatovic
Martha
M
Department of Psychiatry, Case University School of Medicine and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA. martha.sajatovic@uhhs.com
Gyulai
Laszlo
L
Calabrese
Joseph R
JR
Thompson
Thomas R
TR
Wilson
Barbara G
BG
White
Robin
R
Evoniuk
Gary
G
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*
D014150:Antipsychotic Agents; D014227:Triazines; D016651:Lithium Carbonate; D000077213:Lamotrigine