ABSTRACT
BACKGROUND: Lamotrigine is being prescribed increasingly for the treatment of bipolar disorder. In this article we review the current literature on the subject. AIM: To review the literature in order to assess the present position of lamotrigine in the treatment of bipolar disorder. METHOD: We reviewed the literature from 1985 to 2005 by means of PubMed and we also consulted the bibliographic references for the articles we found. In addition, we studied a review article by Goldsmith e. a. (2003). RESULTS: Although a considerable amount of research has been done, evidence for the efficacy of lamotrigine is limited. Lamotrigine was not effective in the treatment of acute mania. In only one of three studies was lamotrigine effective in the treatment of acute depression. In two extensive maintenance studies lamotrigine was found to be effective in preventing new depression episodes; however, the latter studies have such serious methodological weaknesses that the results provide only very limited evidence that lamotrigine is beneficial. CONCLUSION: In the guideline for the treatment of bipolar depression published by the NVVP (the Dutch Psychiatric Association; 2001), lamotrigine was mentioned as a possible treatment option for bipolar disorder and rapid cycling. In view of the results of randomised controlled trials (RCTS) that have been published so far, there is at present no reason to alter the status of lamotrigine.
Subject(s)
Antimanic Agents/therapeutic use , Bipolar Disorder/drug therapy , Calcium Channel Blockers/therapeutic use , Triazines/therapeutic use , Bipolar Disorder/prevention & control , Evidence-Based Medicine , Humans , Lamotrigine , Recurrence , Treatment OutcomeSubject(s)
Clopenthixol/adverse effects , Dyskinesia, Drug-Induced/surgery , Globus Pallidus/surgery , Haloperidol/analogs & derivatives , Haloperidol/adverse effects , Schizophrenia/drug therapy , Athetosis/chemically induced , Athetosis/surgery , Chorea/chemically induced , Chorea/surgery , Clopenthixol/therapeutic use , Delayed-Action Preparations , Dominance, Cerebral/physiology , Drug Therapy, Combination , Dyskinesia, Drug-Induced/etiology , Follow-Up Studies , Haloperidol/therapeutic use , Humans , Male , Middle Aged , Myoclonus/chemically induced , Myoclonus/surgery , Neurologic Examination , Outcome Assessment, Health Care , Treatment OutcomeABSTRACT
In two women aged 35 and 21 years, the initial diagnosis 'borderline personality disorder' was changed to 'bipolar disorder'. These disorders are separate entities with different therapy, but may resemble each other very much. It may be necessary to use heteroanamnesis and family anamnesis and to follow the patient for some time in order to establish whether there are mood disorders.
Subject(s)
Bipolar Disorder/diagnosis , Borderline Personality Disorder/diagnosis , Adult , Antidepressive Agents/therapeutic use , Antimanic Agents/therapeutic use , Bipolar Disorder/drug therapy , Borderline Personality Disorder/drug therapy , Diagnosis, Differential , Female , Humans , Lithium Carbonate/therapeutic useABSTRACT
UNLABELLED: For patients with a bipolar disorder who are pregnant or consider pregnancy, the following issues are of importance: Genetic counselling: genetic vulnerability is virtually certainly the basis of the occurrence of a bipolar disorder. MEDICATION: discontinuation of the medication may lead to recurrence; continuation may cause intoxications in the woman and her child and congenital anomalies in the child. Alternatives to mood stabilizers can be applied; electroconvulsive therapy is a possibility as is medication with antidepressants, antipsychotics and benzodiazepines during acute episodes of mood disorder. Precautions for mother and child if mood-stabilizing treatment is continued: use sustained-release preparations, regularly check blood levels and thyroid function, administer vitamin K if necessary, perform ultrasonoscopy/examination of amniotic fluid, have the child delivered in hospital. Management of the newborn child: observation, determination of blood levels, regular checks of thyroid function, if necessary administration of vitamin K.
Subject(s)
Bipolar Disorder/drug therapy , Pregnancy Complications/drug therapy , Psychotropic Drugs/therapeutic use , Abnormalities, Drug-Induced/etiology , Adult , Bipolar Disorder/genetics , Bipolar Disorder/therapy , Electroconvulsive Therapy , Female , Genetic Counseling , Humans , Infant, Newborn , Postnatal Care , Pregnancy , Prenatal Care , Psychotropic Drugs/adverse effects , Risk AssessmentABSTRACT
In five patients, two women aged 40 and 65 years and three men aged 42, 70 and 84 years, extrapyramidal symptoms such as rigidity and tremors, were considered to be caused by the use of the antidepressant drug sertraline, a serotonin reuptake inhibitor. After discontinuation of the medication the symptoms disappeared.
Subject(s)
1-Naphthylamine/analogs & derivatives , Antidepressive Agents/adverse effects , Basal Ganglia Diseases/chemically induced , 1-Naphthylamine/adverse effects , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Selective Serotonin Reuptake Inhibitors/adverse effects , SertralineABSTRACT
A case is reported of non-fatal acute cerebral haemorrhage in a 47-year-old female who was taking tranylcypromine and who drank 500 ml of normal beer. Since the tyramine contents of several beers, including low alcohol and alcohol free beer, are similar, it is recommended that patients taking tranylcypromine should avoid all kinds of beer.
