Abstract
The efficacy of lamotrigine in the treatment of focal epilepsies have already been reported in several case reports and open studies, which is thought to act by inhibiting glutamate release through voltage-sensitive sodium channels blockade and neuronal membrane stabilization. However, recent findings have also illustrated the importance of lamotrigine in alleviating the depressive symptoms of bipolar disorder, without causing mood destabilization or precipitating mania. Currently, no mood stabilizers are available having equal efficacy in the treatment of both mania and depression, two of which forms the extreme sides of the bipolar disorder. Lamotrigine, a well established anticonvulsant has received regulatory approval for the treatment and prevention of bipolar depression in more than 30 countries worldwide. Lamotrigine, acts through several molecular targets and overcomes the major limitation of other conventional antidepressants by stabilizing mood from “below baseline” thereby preventing switches to mania or episode acceleration, thus being effective for bipolar I disorder. Recent studies have also suggested that these observations could also be extended to patients with bipolar II disorder. Thus, lamotrigine may supposedly fulfill the unmet requirement for an effective depression mood stabilizer.
Highlights
Management of bipolar disorders has given main focus on the treatment of acute mania, while neglecting the treatment of bipolar depression, both of which constitutes the extreme poles of the bipolar disorder (Podawiltz, 2012)
This review highlights the importance of understanding the different mechanisms and pathways contributing to the therapeutic use of the well-established antiepileptic drug lamotrigine in the management of bipolar disorder, being more effective in treating the depressive phase of the disorder as well as how it differs from other clinically relevant mood stabilizers, conventional antidepressants and anticonvulsants in exerting its efficacy over bipolar depression
It was demonstrated that lamotrigine was used either as sole therapy or in adjunct with lithium or valproic acid in the treatment of bipolar depression, which is usually well tolerated
Summary
Management of bipolar disorders has given main focus on the treatment of acute mania, while neglecting the treatment of bipolar depression, both of which constitutes the extreme poles of the bipolar disorder (Podawiltz, 2012). There has been increased interest in the treatment of bipolar disorder by using medications such as carbamazepine and oxcarbazepine, which are the established antiepileptic agents as well as new generation antiepileptics such as lamotrigine and topiramate along with certain most widely used antidepressants were known to exhibit calcium-channel-blocking properties that are relevant to the pathophysiology of epilepsies. This property is desired for alleviating depressive symptoms. Even though mood stabilizing properties are exhibited by other anticonvulsant drugs, several trials have shown lamotrigine to be outstandingly effective in the prevention or amelioration of bipolar depression in patients experiencing episodes of major depression as lamotrigine possess very low propensity for inducing switch to mania, which is major limitation with the use of other conventional antidepressants and for preventing episodes of depression in patients diagnosed with rapid cycling bipolar disorder (Calabrese et al, 1999a,b, 2000, 2001)
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