title: Effectiveness of quetiapine plus lamotrigine maintenance therapy in challenging bipolar disorder patients.
abstract: OBJECTIVE
  Assess quetiapine plus lamotrigine (QTP+LTG) combination maintenance therapy effectiveness in challenging bipolar disorder (BD).
  
  
  METHODS
  Outpatients assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Affective Disorders Evaluation and followed with the STEP-BD Clinical Monitoring Form were naturalistically prescribed QTP+LTG.
  
  
  RESULTS
  Fifty-four outpatients with challenging BD, taking in addition to QTP+LTG, a mean±SD of 2.1±1.6 (in 63.0% at least 2) other psychotropic and 2.3±1.9 non-psychotropic prescription medications, had QTP+LTG maintenance trials. Median(mean±SD) QTP+LTG duration was 401(730±756) days. Final QTP and LTG doses were 87.5(188±211) and 300(287±108) mg/day, respectively. Half (27/54) of patients discontinued QTP (in 19), LTG (in 6), or QTP+LTG (in 2), after 294(415±414) days - due to side-effects in 10, inefficacy in seven, non-adherence in five, and other reasons in five. 42.6%(23/54) had additional pharmacotherapy intervention for emergent mood symptoms, after 175(261±237) days, with at least one psychotropic added (in 16/54) or substantively (by ≥50%) increased (in 7/54). 55.6%(30/54) had recurrent mood episodes, after 126(187±158) days, most often depressive (in 35.2%), although 64.8%(35/54) were euthymic at final visit taking QTP+LTG. Sedation increased significantly during treatment among those with side-effect discontinuations, and 19.2%(10/52, all having QTP added to LTG) had clinically significant (≥7%) weight gain.
  
  
  CONCLUSIONS
  No placebo comparison group. Small sample of predominantly female Caucasian insured outpatients taking complex concurrent medication regimens.
  
  
  CONCLUSIONS
  Additional studies are warranted to confirm our preliminary observation that QTP+LTG maintenance may be effective in patients with challenging BD.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pichai
authors.initials: P
authors.lastname: Ittasakul
authors.forename: Kaja R
authors.initials: KR
authors.lastname: Johnson
authors.forename: Shefali
authors.initials: S
authors.lastname: Srivastava
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Childers
authors.forename: John O
authors.initials: JO
authors.lastname: Brooks
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hoblyn
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D000069348:Quetiapine Fumarate; D014227:Triazines / Q000627:therapeutic use*
chemical_list: D003987:Dibenzothiazepines; D011619:Psychotropic Drugs; D014227:Triazines; D000069348:Quetiapine Fumarate; D000077213:Lamotrigine