Lamotrigine in psychiatric disorders.
OBJECTIVE
Owing to the prevalence of medication side effects and treatment resistance, prescribers often consider off-label uses of US Food and Drug Administration (FDA)-approved agents for the treatment of persistent symptoms. The authors review the available literature on the FDA-approved and non-FDA-approved uses of lamotrigine in adults with psychiatric disorders.


METHODS
We used PubMed, MEDLINE, and a hand search of relevant literature to find studies published between 1990 and 2012 and available in English language. The following keywords were searched: lamotrigine, psychiatric, mood disorders, depression, personality disorders, anxiety, schizophrenia, side effects, and rash.


METHODS
Data were selected from 29 randomized controlled trials (RCTs). When RCTs were not available, open-label trials (6), retrospective case reviews (10), and case series (4) were summarized.


METHODS
We extracted results of monotherapy and augmentation trials of lamotrigine on primary and secondary outcome measures.


RESULTS
Lamotrigine is generally well tolerated, with the best evidence for the maintenance treatment of bipolar disorder, particularly in prevention of depressive episodes. In acute bipolar depression, meta-analyses suggested a modest benefit, especially for more severely depressed subjects, with switch rates similar to placebo. In unipolar depression, double-blind RCTs noted benefit on subsets of symptoms and improved response in more severely depressed subjects. Data are limited but promising in borderline personality disorder. Use of lamotrigine in schizophrenia and anxiety disorders has little supportive evidence.


CONCLUSIONS
Lamotrigine is recommended in bipolar maintenance when depression is prominent. It also has a role in treating acute bipolar depression and unipolar depression, though the latter warrants more research. Data are too limited in other psychiatric disorders to recommend its use at this time.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Jennifer G
JG
Reid
Michael J
MJ
Gitlin
Lori L
LL
Altshuler
D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D003863:Depression / Q000188:drug therapy*; D017277:Drug Approval; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D016021:Epidemiologic Studies; D006801:Humans; D000077213:Lamotrigine; D054539:Medication Therapy Management; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology; D056687:Off-Label Use; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects
D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine