title: Olanzapine is superior to lamotrigine in the prevention of bipolar depression: a naturalistic observational study.
abstract: BACKGROUND
  Bipolar disorder is a highly recurrent disease and has great impact on the function of patients. Depressive symptoms consist of more than 50% of life time during the illness and may lead to self harm or suicidal behaviors. Little is known about the antidepressant effects of olanzapine, an atypical antipsychotic, as monotherapy despite its indication for preventing manic episodes. In contrast, lamotrigine, a mood stabilizer, has been proven to be effective in preventing depression in patients with bipolar disorder. However, no studies have compared the efficacy between lamotrigine and olanzapine in the maintenance treatment of bipolar disorder. This enriched naturalistic study was implemented to assess the effectiveness of olanzapine and lamotrigine as monotherapy in the prevention of recurrence of bipolar disorder.
  
  
  METHODS
  Patients with bipolar disorder in a euthymic state (Young's Mania Rating Scale (YMRS) score <12, and 21-item Hamilton Depression Rating Scale (HAM-D) score <7) for at least two months, having already received either olanzapine or lamotrigine as the maintenance treatment were recruited. The patients maintained with olanzapine (n = 22) were applied to olanzapine group whereas those maintained with lamotrigine (n = 29) were applied to lamotrigine group. They were followed up for 12 months. Differences in the efficacy between olanzapine and lamotrigine in recurrence prevention were analyzed. The Kaplan-Meier method was used to generate time-to-recurrence curves, and differences between the two groups were compared using the log-rank test.
  
  
  RESULTS
  Olanzapine had a significantly lower recurrence rate of depressive episodes than lamotrigine (20.0% vs. 57.7%, χ2 = 6.62, p = .010). However, olanzapine and lamotrigine had similar mania (15.0% vs. 0%, χ2 = 4.17, p = .075, Fisher's exact test) and any mood episode (35.0% vs. 57.7%, χ2 = 2.33, p = .127) recurrence rates. Olanzapine was significantly superior to lamotrigine in the time to recurrence of depressive episodes (χ2 = 4.55, df = 1, p = .033), but there was no difference in the time to recurrence of any mood episode (χ2 = 1.68, df = 1, p = .195).
  
  
  CONCLUSIONS
  This prospective naturalistic study suggests that olanzapine is more effective than lamotrigine in the prevention of depressive episodes in patients with bipolar disorder. Future large-scale randomized studies are warranted to validate our results.
  
  
  BACKGROUND
  ClinicalTrials.gov ID NCT01864551.
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Pan
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Miao-Chi
authors.initials: MC
authors.lastname: Lo
authors.forename: En-Lin
authors.initials: EL
authors.lastname: Yang
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No, 325, Cheng-Kung Road, Sec, 2, Nei-Hu District, Taipei 114, Taiwan, R,O,C. chinbinyeh@gmail.com.
authors.forename: Chin-Bin
authors.initials: CB
authors.lastname: Yeh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D003866:Depressive Disorder / Q000209:etiology / Q000517:prevention & control; D000077213:Lamotrigine; D000077152:Olanzapine; D011446:Prospective Studies; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077213:Lamotrigine; D000077152:Olanzapine; D014227:Triazines