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By Nancy Menefee Jackson, HealthAtoZ contributing writer
Treating bipolar disorder with medication has been frustrating for patients and mental health professionals alike because drugs seem to help the too-high highs, but not the too-low lows.
Now doctors have another drug in their arsenal - a medication that prevents seizures can also help treat bipolar disorder. That drug is lamotrigine (Lamictal®), which has been found to be effective at delaying relapse into the mood episodes associated with bipolar disorder, particularly the depressed moods.
The drug was tested in two double-blind, placebo-controlled, long-term maintenance studies. The most recent, an 18-month study, involved 349 patients, and the results were published in the Archives of General Psychiatry in 2003. The Food and Drug Administration has approved this medication for keeping depressive episodes at bay.
Joseph Calabrese, M.D., one of the study's authors, a professor of psychiatry at Case Western Reserve and director of the Mood Disorders Center at the University Hospitals of Cleveland, says both Lamictal and lithium were more effective than a dummy pill in delaying relapse into a mood episode.
Lamictal was particularly effective in the prevention of depressive episodes and lithium was particularly effective in the prevention of manic episodes. "That's what we wanted to see," Calabrese says, adding that existing mood stabilizers, such as lithium and Depakote®, are effective, but they tend to work on the manic phase of the disease.
Lamictal works particularly well on the depression, Calabrese says, pointing out that the drug treats "the major unmet need in the treatment of bipolar disorder."
Typically, Calabrese says, bipolar patients are started on lithium, but that usually works better to control the mania. When patients relapse, they more commonly relapse into depression, and Lamictal promises to relieve that.
The conventional antidepressants, such as the selective serotonin reuptake inhibitors (Prozac®, Paxil® and Zoloft®), have not been shown to stabilize mood by preventing depressive episodes in patients with bipolar disorder. (Editor's Note: Antidepressants may increase the risk of suicide or worsen depression, especially when starting the medication or when the dose is changed.)
"The drug was originally hypothesized to be effective simply because it was an anticonvulsant drug, and we now know that medications used to treat epilepsy such as divalproex sodium and carbamazepine, have been shown to stabilize mood," Calabrese says. "No one predicted this would be the mirror image to lithium."
The most common side effects of Lamictal include rash and headache.
Sufferers need help
Getting patients diagnosed is critical. Based on data published in the January 2003 issue of the Journal of Clinical Psychiatry, Calabrese says, only about 20 percent of people in the United States who have bipolar disorder get diagnosed. The authors of the article estimate 8 million adults in the United States have the disorder.
Calabrese says people will seek help when they're depressed but not necessarily when they're feeling euphoric or elated. "So they'll report to their doctor for treatment of depression, but less frequently for treatment of mood swings."
The symptoms of the depressive phase of the illness are the same as for clinical depression, such as changes in appetite and sleep patterns and lack of interest in activities once found stimulating. But the symptoms of the manic phase of the illness include racing thoughts, increased energy, talkativeness, impulsiveness often typified by a spending spree and even grandiose thoughts.
In someone with bipolar disorder, the depression alternates with elated moods or with irritable moods. Bipolar disorder often begins in childhood, where it can be mistaken for attention deficit disorder, as well as in adolescence.
Without effective treatment, the disease destroys lives and relationships.
"It's a mood disorder with a huge impact on people," Calabrese says. "Ten percent to 15 percent will kill themselves if never treated. Half as many people with it get married, and of those who do, twice as many get divorced or separated."
But Calabrese wants to get the message out: This disease is treatable - the problem is that the majority never get diagnosed and treated.
This article was reviewed and updated June 2007.
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