EC Pharmacology and Toxicology

Introduction:  Bipolar disorder is a difficult to treat condition where mood stabilizers play a major role along with adjunctive therapy.

Objectives: Objectives of this study were to evaluate Lamotrigine in the treatment of Bipolar depression; to assess the role of psychosocial factors in modifying the response to treatment and also to evaluate treatment satisfaction with medication.

Methodology: Patients diagnosed with bipolar disorder receiving Lamotrigine with or without other mood stabilizers were administered Hamilton rating scale for depression (HAM-D) at week 0 and week 4. The HAM-D scores were compared to evaluate efficacy. Patients were also administered a Trauma Experience Checklist (TEC) at week 0 to report whether any traumatizing event existed in their life that could modify response to treatment. These events were classified as acute, chronic or no stressor. HAM-D scores in patients with different stressors were evaluated to find out if any correlation existed between stressors and response to treatment. A questionnaire regarding patient satisfaction with treatment (TSQM version 1.4) was administered at week 4. Mann-Whitney U test and Wilcoxon Rank Sum tests were used for calculating the statistics and p value <0.05 was considered significant.

Result: 37 patients diagnosed with bipolar disorder receiving Lamotrigine 200mg/day were enrolled in the study.  13 patients received other mood stabilizers like lithium or valproate. Adjunctive drugs included hypnotics, antipsychotics, antidepressants and miscellaneous drugs. There was significant improvement in HAM-D scores in patients with mild, moderate and severe depression. There was significant improvement in depression associated parameters like depressed mood, suicidal thoughts, anxiety, insomnia, somatic symptoms and work and activities. Patients with no stressors and acute stressors showed a greater response to therapy as compared to chronic stressors. In them the response was significant. Patient satisfaction with treatment was 93% both in euthymic patients and patients with depression.

Conclusion: lamotrigine is efficacious in the treatment of Bipolar disorder; both for maintenance of euthymia and improvement of depression. Presence of chronic stressors in patient’s life have a detrimental effect on response to treatment as compared to no stressors and acute stressors. We found patient satisfaction with treatment of about 93%.

Keywords: Lamotrigine; Bipolar Depression; Patient Satisfaction With Treatment; Trauma Experience

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