Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-05T02:57:17.794Z Has data issue: false hasContentIssue false
  • English
  • Français

Gabapentin and Lamotrigine: Novel Treatments for Mood and Anxiety Disorders

Published online by Cambridge University Press:  07 November 2014

Mark H. Pollack  and
Erin L. Scott
Get access Rights & Permissions [Opens in a new window]

Abstract

Clinical experience and systematic inquiry demonstrate that many patients with mood and anxiety disorders remain symptomatic despite standard interventions. These observations have prompted the search for alternative pharmacotherapeutic treatment options. Anticonvulsants, including valproic acid and carbamazepine, have demonstrated benefit for a number of psychiatric conditions. Recently, clinical and research attention has focused on the use of the new anticonvulsants gabapentin and lamotrigine as alternatives to standard pharmacotherapies for the treatment of mood and anxiety disorders. This paper reviews the experience to date with these agents in the treatment of psychiatric conditions. Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatment of bipolar disorder.

Type
Grand Rounds
Information
CNS Spectrums , Volume 2 , Issue 10: New Research: Functional Imaging, Phylogenetic Models, and Pharmacoeconomics , December 1997 , pp. 56 - 61
Copyright
Copyright © Cambridge University Press 1997

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

1.Post, RM, Ketter, TA, Denicoff, K, et al.The place of anticonvulsant therapy in bipolar illness. Psychopharmacology. 1996;128:115–129.CrossRefGoogle ScholarPubMed
2.Post, RM, Uhde, TW, Roy-Byrne, PP, Joffe, RT. Correlates of antimanic response to carbamazepine. Psychiatry Res. 1987;21:71–83.Google Scholar
3.Cullen, M, Mitchell, P, Brodaty, H, et al.Carbamazepine for treatment-resistant melancholia. J Clin Psychiatry. 1991;52:472–476.Google ScholarPubMed
4.Reis, R, Roy-Byrne, P, Ward, NG, Neppe, V, Cullison, S. Carbamazepine treatment for benzodiazepine withdrawal. Am J Psychiatry. 1989;146:536–537.Google Scholar
5.Uhde, TW, Stein, MB, Post, RM. Lack of efficacy of carbamazepine in the treatment of panic disorder. Am J Psychiatry. 1988;145:1104–1109.Google Scholar
6.Bowden, CL, Brugger, AM, Swann, AC, et al.Efficacy of divalproex versus lithium and placebo in the treatment of mania. JAMA. 1994;271:918–924.Google Scholar
7.Roy-Byrne, PP, Ward, NG, Donnelly, PJ. Valproate in anxiety and withdrawal syndromes. J Clin Psychiatry. 1989;50(suppl):44–48.Google Scholar
8.Keck, PE Jr, Taylor, VE, Tugrul, KC, McElroy, SL, Bennett, JA. Valproate treatment of panic disorder in lactate-induced panic attacks. Biol Psychiatry. 1993;33:542–546.CrossRefGoogle ScholarPubMed
9.Taylor, CP, Vartanian, MG, Andruszkiewicz, R, Silverman, RB. 3-alkyl GABA and 3-alkylglutamic acid analogues: two new classes of anticonvulsant agents. Epilepsy Res. 1992;11:103–110.Google Scholar
10.Kocsis, JC, Honmou, O. Gabapentin increases GABA-induced depolarization in rat neonatal optic nerve. Neurosci Lett. 1994;169:181–184.CrossRefGoogle ScholarPubMed
11.Reimann, W. Inhibition by GABA, baclofen, and gabapentin of dopamine release from rabbit caudate nucleus: are there common or different sites of action? Eur J Pharmacol. 1983;94:341–344.Google Scholar
12.Schlicker, E, Reimann, WGothert, M. Gabapentin decreases monoamine release without affecting acetylcholine release in the brain. Arzneimitteltorschung. 1985;35(9):1347–1349.Google ScholarPubMed
13.Suman-Chauhan, N, Webdale, L, Hill, Dr, et al.Characterization of [3H[-gabapentin binding to a novel site in rat brain: homogenate binding studies. Eur J Pharmacol. 1993;244:293–301.CrossRefGoogle ScholarPubMed
14.Rao, ML, Clarenbach, P, Vahlensieck, M, Kratzschmar, S. Gabapentin augments whole blood serotonin in healthy young men. J Neural Transm. 1988;73:129–134.Google Scholar
15.Saletu, B, Grhnberger, J, Linzmayer, L. Evaluation of encephalotropic and psychotropic properties of gabapentin in man by pharmaco-EEG and psychometry. Int J Clin Pharmacol Ther Toxicol. 1986;24:362–373.Google Scholar
16.Stewart, BH, Kugler, AR, Thompson, PR, Bockbrader, HN. A saturable transport mechanism in the intestinal absorption of gabapentin is the underlying cause of the lack of proportionality between increasing dose and drug levels in plasma. Pharmacol Res. 1993;10:276–281.CrossRefGoogle ScholarPubMed
17.Busch, JA, Radulovic, LL, Bockbrader, HN, Underwood, BA, Sedman, AJ, Chang, T. Effect of Maalox TC on single-dose pharmacokinetics of gabapentin capsules in healthy subjects. Pharmacol Res. 1992;9(suppl):S315.Google Scholar
18.McClean, MJ. Clinical pharmacokinetics of gabapentin. Neurology. 1994;44(suppl 5);S17–S22.Google Scholar
19.Blum, RA, Comstock, TJ, Sica, DA, et al.Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clin Pharmacol Ther. 1994;56:154–159.CrossRefGoogle ScholarPubMed
20.Ramsay, RE. Clinical efficacy and safety of gabapentin. Neurology. 1994;44:(suppl 5):S23–S30.Google ScholarPubMed
21.Marson, AG, Kadir, ZA, Chadwick, DW. New antiepileptic drugs: a systematic review of their efficacy and tolerability. Br Med J. 1996;313:1169–1174.CrossRefGoogle ScholarPubMed
22.Fischer, JH, Barr, AN, Rogers, SL, Fischer, PA, Trudeau, VL. Lack of serious toxicity following gabapentin overdose. Neurology. 1994;44:982–983.Google Scholar
23.Kastrup, EK, ed. Drug Facts and Comparisons. St Louis, Mo: Facts and Comparisons Inc; 1997:283–285.Google Scholar
24.Dimond, KR, Pande, AC, Lamoreaux, L, Pierce, MW. Effect of gabapentin (Neurontin®) on mood and well-being in patients with epilepsy. Prog Neuropsychopharmacol Biol Psychiatry. 1996;20:407–417.Google Scholar
25.Ryback, R, Ryback, L. Gabapentin for behavioral dyscontrol. Am J Psychiatry. 1995;152:1399. Letter.Google Scholar
26.Stanton, SP, Keck, PE Jr, McElroy, SL. Treatment of acute mania with gabapentin. Am J Psychiatry. 1997:154:287. Letter.Google ScholarPubMed
27.McElroy, SL, Soutullo, CA, Keck, PE, Kmetz, GF. A pilot trial of adjunctive gabapentin in the treatment of bipolar disorder. Ann Clin Psychiatry. In press.Google Scholar
28.Bennett, J, Goldman, WT, Suppes, T. Gabapentin for the treatment of bipolar and schizoaffective disorders. J Clin Psychopharmacol. 1997;17:141–142. Letter.Google Scholar
29.Schaffer, CB, Schaffer, LC. Gabapentin in the treatment of bipolar disorder. Am J Psychiatry. 1997:154:291. Letter.Google ScholarPubMed
30.Short, C, Cooke, L. Hypomania induced by gabapentin. Br J Psychiatry. 1995;166:679–680.CrossRefGoogle ScholarPubMed
31.Singh, L, Field, M, Oles, R, Ninteman, F, Heffner, T, Hughes, J. Anxiolytic effects of gabapentin in preclinical tests. Proceedings of the 35th Annual Meeting of the American College of Neuropharmacology; December 9–13, 1996; San Juan, Puerto Rico.Google Scholar
32.Beauclair, L, Sultan, S, Balanger, MC, Choinard, G. Antianxiety and hypnotic effects of gabapentin in psychotic patients with comorbid anxiety related disorders. Proceedings of the 35th Annual Meeting of the American College of Neuropharmacology; December 9–13, 1996; San Juan, Puerto Rico.Google Scholar
33.Pollack, MH, Matthews, J, Scott, EL. Gabapentin for refractory anxiety. Am J Psychiatry. In press.Google Scholar
34.Messenheimer, JA. Lamotrigine. Epilepsia. 1995;36(suppl 2):S87–S94.Google Scholar
35.White, HS. Clinical significance of animal seizure models and mechanism of action studies of potential antiepileptic drugs. Epilepsia. 1997;38(suppl 1):S9–S17.CrossRefGoogle ScholarPubMed
36.Cohen, AF, Land, GS, Breimer, DD, Yuen, WC, Winton, C, Peck, A. Lamotrigine, a new anticonvulsant: pharmacokinetics in normal humans. Clin Pharmacol Ther. 1987;42:535–541.CrossRefGoogle ScholarPubMed
37.Warner, T, Patsalos, PN, Prevett, M, Elyas, AA, Duncan, JS. Lamotrigine-induced carbamazepine toxicity: an interaction with carbamazepine-10, 11-epoxide. Epilepsy Res. 1992;11:147–150.Google Scholar
38.Walker, MC, Patsalos, PN. Clinical pharmacokinetics of new antiepileptic drugs. Pharmacol Ther. 1995:67:351–384.Google Scholar
39.Richens, A. Safety of lamotrigine. Epilepsia. 1994;35(suppl 5):S37–S40.Google Scholar
40. Lamictal® package insert, Glaxo-Wellcome, 1997.Google Scholar
41.Smith, D, Baker, G, Davies, G, Dewey, M, Chadwick, DW. Outcomes of add-on treatment with lamotrigine in partial epilepsy. Epilepsia. 1993;34:312–322.Google Scholar
42.Smith, D, Chadwick, D, Baker, G, Davis, G, Dewey, M. Seizure severity and the quality of life. Epilepsia. 1993;34(suppl 5):S31–S35.Google Scholar
43.Baker, GA, Jacoby, A, Smith, D, Dewey, M, Johnson, AL, Chadwick, D. Quality of life in epilepsy: the Liverpool initiative. In: Trimble, MR, Dodson, E, eds. Epilepsy and Quality of Life. New York, NY: Raven Press; 1994:135–150.Google Scholar
44.Weisler, R, Risner, ME, Ascher, J, Houser, T. Use of lamotrigine in the treatment of bipolar disorder. American Psychiatry Association Meeting; May 21–26, 1994; Philadelphia, Pa. Abstract.Google Scholar
45.Calabrese, JR, Bowden, CL, Rhodes, LJ, et al. Lamotrigine in treatment-refractory bipolar disorder. Proceedings of the American Psychiatric Association Annual Meeting; May 4–9, 1996; New York, NY. Abstract.Google Scholar
46.Walden, J, Hesslinger, B, van Calker, D, Berger, M. Addition of lamotrigine to valproate may enhance efficacy in the treatment of bipolar affective disorder. Pharmacopsychiatry. 1994;29:193–195.CrossRefGoogle Scholar
47.Sporn, J, Sachs, G. Anticonvulsants in treatment resistant manic-depressive illness. J Clin Psychopharmacol. 1997;17:185–189.Google Scholar
48.Prien, RF, Gelenberg, AJ. Alternatives to lithium for preventive treatment of bipolar disorder. Am J Psychiatry. 1989;146:840–848.Google Scholar
49.Pollack, MH, Smoller, JW. The longitudinal course and outcome of panic disorder. Psychiatr Clin North Am. 1995;8:785–801.Google Scholar