Brown E Sherwood, Nejtek Vicki A, Perantie Dana C, Orsulak Paul J, Bobadilla Leonardo
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75390, USA.
J Clin Psychiatry. 2003 Feb;64(2):197-201. doi: 10.4088/jcp.v64n0213.
Bipolar disorder is associated with the highest substance abuse rates of any psychiatric illness. Therefore, treatments that stabilize mood and decrease drug use or cravings are of great interest. Open-label lamotrigine was examined in 30 outpatients with DSM-IV bipolar disorder and cocaine dependence. Lamotrigine was either added to existing medication regimens or used as monotherapy.
Lamotrigine was started at a dose of 25 mg/day (12.5 mg/day in those taking valproic acid) and titrated to a maximum dose of 300 mg/day. Subjects received a baseline evaluation including a structured clinical interview and weekly assessments for 12 weeks with the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Cocaine Craving Questionnaire (CCQ). At each appointment, a urine sample was obtained, and participants reported drug use during the previous week. The subjects consisted of 13 men and 17 women with cocaine dependence and bipolar I disorder (N = 22), bipolar II disorder (N = 7), or bipolar disorder not otherwise specified (N = 1), with a mean +/- SD age of 35.4 +/- 7.2 years. Data were analyzed using the last observation carried forward on all subjects who completed the baseline evaluation and at least 1 postbaseline assessment.
Significant improvement was observed in HAM-D, YMRS, and BPRS scores (p < or =.02). Cravings also significantly decreased as measured by the CCQ (p <.001). Dollar amount spent on drugs decreased nonsignificantly. Lamotrigine was well tolerated, with no subjects discontinuing due to side effects.
Lamotrigine treatment was well tolerated in this sample and associated with statistically significant improvement in mood and drug cravings but not drug use. The findings suggest that larger controlled trials of lamotrigine are needed in this population.
双相情感障碍与所有精神疾病中最高的物质滥用率相关。因此，稳定情绪并减少药物使用或渴望的治疗方法备受关注。对30名患有DSM-IV双相情感障碍和可卡因依赖的门诊患者进行了开放标签的拉莫三嗪研究。拉莫三嗪要么添加到现有的药物治疗方案中，要么用作单一疗法。
拉莫三嗪起始剂量为25毫克/天（服用丙戊酸的患者为12.5毫克/天），并滴定至最大剂量300毫克/天。受试者接受了基线评估，包括结构化临床访谈，并使用汉密尔顿抑郁量表（HAM-D）、杨氏躁狂量表（YMRS）、简明精神病评定量表（BPRS）和可卡因渴望问卷（CCQ）进行为期12周的每周评估。每次就诊时采集尿液样本，参与者报告前一周的药物使用情况。受试者包括13名男性和17名女性，患有可卡因依赖和双相I型障碍（N = 22）、双相II型障碍（N = 7）或未另行指定的双相情感障碍（N = 1），平均年龄±标准差为35.4±7.2岁。对所有完成基线评估且至少进行1次基线后评估的受试者，使用末次观察值结转法进行数据分析。
HAM-D、YMRS和BPRS评分有显著改善（p≤0.02）。根据CCQ测量，渴望也显著降低（p＜0.001）。在药物上花费的金额无显著下降。拉莫三嗪耐受性良好，没有受试者因副作用而停药。
在该样本中，拉莫三嗪治疗耐受性良好，与情绪和药物渴望的统计学显著改善相关，但与药物使用无关。研究结果表明，需要对该人群进行更大规模的拉莫三嗪对照试验。
