Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T04:24:21.611Z Has data issue: false hasContentIssue false
  • English
  • Français

Lamotrigine Augmentation Strategy for Patients with Treatment-Resistant Depression

Published online by Cambridge University Press:  07 November 2014

Rosben L. Gutierrez ,
Ruth McKercher ,
Jason Galea  and
Katrina L. Jamison
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate if lamotrigine added to an antidepressant regimen reduces the symptoms of major depression in treatment-resistant patients.

Introduction:

Charts were retrospectively reviewed for 34 patients (36–63 years of age) with major depressive disorder who received lamotrigine augmentation to the antidepressant regimen for treatment-resistant depression (TRD). Data collection occurred at baseline and at an average of 30 (Time 2), 78 (Time 3), 167 (Time 6), and 356 days (Time 12), thereafter, using a “Medication Visit by MD” scale for collection of target symptom data at each timepoint.

Results:

Following the addition of lamotrigine to the antidepressant regimen (mean dose of 43, 63, and 113 mg/day for Time 3, Time 6, and Time 12, respectively), a statistically significant reduction of scores was shown as early as Time 2 for target symptoms of depressed mood, loss of interest, anxiety, irritability, (low) energy, and cognitive impairment. The difference from baseline remained statistically significant at Time 3, Time 6, and Time 12 (with the exception of irritability, which was not statistically significant at Time 6). “Patient's response” also reflected statistically significant improvement at each time period compared with baseline. The most common side effect reported and reason for discontinuation was tiredness.

Discussion:

Because TRD is a clinical condition that can present with severe and disabling symptoms, many clinicians are faced with an urgent need to find relief for their patients. Trying to achieve symptom improvement in a timely manner during a medication change can be challenging and difficult. This can be managed by an augmentation strategy using a psychotropic add-on to an existing medication regimen. Our results show the benefits of lamotrigine augmentation to an antidepressant regimen. Prospective, controlled clinical trials with larger sample size are needed to confirm our results.

Conclusion:

In this retrospective chart review, augmentation with lamotrigine was a tolerable and efficacious strategy for treating patients with TRD.

Type
Original Research
Information
CNS Spectrums , Volume 10 , Issue 10 , October 2005 , pp. 800 - 805
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Amsterdam, JD, Hornig-Rohan, M. Treatment algorithms in treatment-resistant depression. Psychiatr Clin North Am. 1996;19:371–386.Google Scholar
2.Fawcett, J. Progress in treatment-resistant and treatment-refractory depression: we still have a long way to go. Psychiatr Ann. 1994;24:214–216.Google Scholar
3.Nierenberg, AA, Amsterdam, JD. Treatment-resistant depression: definition and treatment approaches. J Clin Psychiatry. 1990;51(suppl):39–47.Google Scholar
4.Roose, SP, Glassman, AH, Walsh, BT, Woodring, S. Tricyclic nonresponders: phenomenology and treatment. Am J Psychiatry. 1986;143:345–348.Google Scholar
5.Thase, ME. New approaches to managing difficult-to-treat depressions. J Clin Psychiatry. 2003;64(suppl 1);3–4.Google Scholar
6.Barbee, JG, Jamhour, NJ. Lamotrigine as an augmentation agent in treatment-resistant depression. J Clin Psychiatry. 2002;63:737–741.CrossRefGoogle ScholarPubMed
7.Barbosa, L, Berk, M, Vorster, M. A double-blind, randomized, placebo-controlled trial of augmentation with lamotrigine or placebo in patients concomitantly treated with fluoxetine for resistant major depressive episodes. J Clin Psychiatry. 2003;64:403–407.Google Scholar
8.Rocha, FL, Hara, C. Lamotrigine augmentation in unipolar depression. Int Clin Psychopharmacol. 2003;18:97–99.Google Scholar
9.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
10.Statistical Package for the Social Sciences database 11.01 for Windows. standard ver. Chicago, Ill: SPSS Inc; 2001.Google Scholar
11.Goodwin, GM, Bowden, CL, Calabrese, JR, et al.A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry. 2004;65:432–441.Google Scholar
12.Thase, ME. Therapeutic alternatives for difficult-to-treat depression: a narrative review of the state of the evidence. CNS Spectr. 2004;9:808–821.CrossRefGoogle ScholarPubMed
13.Souery, D, Van der, AK. The multiple facets of treatment-resistant depression. CNS Spectr. 2004;9:803–807.Google Scholar
14.Klein, N, Sacher, J, Wallner, H, Tauscher, J, Kasper, S. Therapy of treatment resistant depression: focus on the management of TRD with atypical antipsychotics. CNS Spectr. 2004;9:823–832.Google Scholar
15.Carpenter, LL, Yasmin, S, Price, LH. A double-blind, placebo-controlled study of anti-depressant augmentation with mirtazapine. Biol Psychiatry. 2002;15:51:183–188.CrossRefGoogle Scholar
16.Normann, C, Hummel, B, Scharer, LO, Horn, M, Grunze, H, Walden, J. Lamotrigine as adjunct to paroxetine in acute depression: a placebo-controlled, double-blind study. J Clin Psychiatry. 2002;63:337–344.Google Scholar