Lamotrigine treatment of bipolar disorder: Data from the first 500 patients in STEP-BD

Marangell LB, Martinez JM, Ketter TA, Bowden CL, Goldberg JF,Calabrese JR, Miyahara S, Miklowitz DJ, Sachs GS, Thase ME.Lamotrigine treatment of bipolar disorder: data from the first 500patients in STEP-BD.Bipolar Disord 2004: 6: 139–143. a Blackwell Munksgaard, 2004Objective: To describe the frequency and correlates of lamotriginetherapy among the first 500 patients enrolled into the SystematicTreatment Enhancement Program for Bipolar Disorder (STEP-BD)study.Method: Systematic recording of psychiatric history and medicationdata at intake into the STEP-BD project.Results: Of the participants with bipolar disorder type I or II(n ¼ 483), 77 (15.4%) were currently taking lamotrigine (mean dose:258.12 mg/day) and 52 (10.4%) reported prior lamotrigine use. Thegroups were comparable with regard to duration of illness and moodstate at study entry. Compared with participants who had never takenlamotrigine, those currently treated with lamotrigine were significantlymore likely to have a prior history of rapid cycling (62.5% vs. 43.1%;p < 0.01)andanantidepressant-inducedswitchto(hypo)mania(49.3%vs. 33.3%; p < 0.01). In contrast, only 16.9% of lamotrigine-treatedparticipantsweretakinganantidepressantatstudyintake,ascomparedwith 29.1% of participants with no history of lamotrigine therapy(p < 0.03).Conclusions: While noting the limitations of a cross-sectionalassessment, these data suggest that lamotrigine therapy was commonlyusedintheseacademiccentersforpatientswithbipolardisorderseveralyears before it was recommended in the American PsychiatricAssociationpracticeguidelines,particularlyinpatientswithahistoryofrapid cycling or antidepressant-induced mania.