Lamotrigine add-on therapy to venlafaxine treatment in adolescent-onset bipolar II disorder: a case report covering an 8-month observation period.
Observations made with lamotrigine add-on therapy with venlafaxine in this case give clues for some aspects of its use in adolescent-onset bipolar II disorder. An 18-year-old adolescent boy with a 3-year history of bipolar II disorder had experienced 2 episodes of hypomania and 4 episodes of major depression. He had been depressed for the last 3 months and had taken olanzapine 5 mg daily for over 6 weeks as mood stabilizer but was still depressed at referral. Other aspects of the patient history included anhedonia, psychomotor retardation, poor concentration, a feeling of hopelessness, hypersomnia, overeating, weight gain, low energy and a refusal to attend school. Parents reported that his symptoms had recently become more severe. His medicine was replaced by venlafaxine, which has a more rapid onset of action and is often used in bipolar depression, especially in patients with atypical depression. Since the clinical response at 6 weeks was only partial, lamotrigine was added to this regimen. The patient responded to lamotrigine after 3 weeks of treatment while on a dose of 50 mg/ day. After 6 weeks of treatment, whilst on a dose of 75 mg/day, his symptoms remitted completely with no evidence of any adverse effects. At the time of publication of this article, the patient had remained euthymic for a total of 8 months. The present report shows that lamotrigine add-on therapy with venlafaxine facilitated clinical remission and that this combination is well tolerated.
Bildik
T
T
Department of Child Psychiatry, School of Medicine, Ege University, Izmir, Turkey. tezanbildik@yahoo.com
Tamar
M
M
Korkmaz
S
S
Gokcen
S
S
Ozbaran
B
B
Erermis
S
S
Aydin
C
C
D000293:Adolescent; D017668:Age of Onset; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003511:Cyclohexanols / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use*; D000069470:Venlafaxine Hydrochloride
D018687:Antidepressive Agents, Second-Generation; D018692:Antimanic Agents; D003511:Cyclohexanols; D014227:Triazines; D000069470:Venlafaxine Hydrochloride; D000077213:Lamotrigine