Effect of open-label lamotrigine as monotherapy and adjunctive therapy on the self-assessed cognitive function scores of patients with bipolar I disorder.
Cognitive deficits in patients with bipolar disorder are likely to impair occupational and social functioning. In a post hoc analysis of data from a prospective, open-label study of lamotrigine in 1175 patients 13 years or older with bipolar I disorder, changes in the self-rated cognitive function scores of patients receiving lamotrigine as monotherapy or as adjunctive therapy were evaluated. Lamotrigine was given for 12 weeks, with a target dosage of 200 mg/d. Cognitive function was assessed at baseline and week 12 with the self-rated Medical Outcomes Study Cognitive (MOS-Cog) Scale. Mean MOS-Cog scores improved significantly from baseline in the overall group (+8.4 +/- 22.55 points, P < 0.0001) and in subgroups of patients receiving and not receiving concomitant valproate, antidepressants, or antipsychotics. Patients receiving lamotrigine and not receiving concomitant antipsychotics, however, exhibited a small but significantly greater degree of improvement than patients who were receiving concomitant antipsychotics (adjusted mean difference = 4.05; 95% confidence interval, 1.30-6.81; P = 0.0039). Statistically significant improvement was seen in patient subgroups with a depressive (mean change from baseline, 8.8 +/- 21.97; P < 0.0001) or a manic (mean change from baseline, 7.5 +/- 22.62; P = 0.0007) index episode. Improvements in MOS-Cog scores significantly correlated with improvement in both depressive (correlation coefficient, -0.339; P < 0.0001) and manic (correlation coefficient, -0.151; P < 0.0001) symptoms. Overall, self-rated cognitive function scores improved during open-label lamotrigine therapy in patients with bipolar I disorder whether or not they were receiving concomitant valproate, antidepressants, or antipsychotics. Additional research is needed to explore the clinical relevance of these findings.
Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, PA, USA. NSKaye@aol.com
Neil S
NS
Kaye
Jay
J
Graham
Jeremy
J
Roberts
Thomas
T
Thompson
Kevin
K
Nanry
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D014227:Triazines / Q000627:therapeutic use*; D014635:Valproic Acid / Q000627:therapeutic use
D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D014227:Triazines; D014635:Valproic Acid; D000077213:Lamotrigine