Pavuluri Mani N, Henry David B, Moss Melissa, Mohammed Tahseen, Carbray Julie A, Sweeney John A
University of Illinois at Chicago, Chicago, Illinois, USA.
J Child Adolesc Psychopharmacol. 2009 Feb;19(1):75-82. doi: 10.1089/cap.2008.0107.
The aim of this study was to test the effectiveness and safety of lamotrigine in maintenance of manic and depressive symptom control in pediatric bipolar disorder (PBD).
A 14-week open trial was conducted with 46 subjects presenting with mania or hypomania. Lamotrigine was slowly titrated to a therapeutic dose over an 8-week period, during which acute symptoms were stabilized using second-generation antipsychotics (SGA), followed by a 6-week lamotrigine monotherapy phase.
The response rate on manic symptoms (Young Mania Rating Score [YMRS] <12) was 72%, on depressive symptoms was 82% (Children's Depression Rating Scale-Revised [CDRS-R] <40), and the remission rate was 56% at the 14-week end point, on an average end-point lamotrigine dose of 1.8 mg/lb. There was further reduction in depressive symptoms during the lamotrigine maintenance phase. Benign rash was noted in 6.4% of patients. Out of half of the subjects who were in remission at 8 week, 3 subjects (23%) relapsed by week 14.
Lamotrigine monotherapy appears to be effective in maintaining symptom control of manic and depressive symptoms in PBD and shows minimal adverse effects, although a future double-blind controlled trial is needed to confirm this finding. Portal of entry for lamotrigine treatment can be during acute illness and can sustain symptom control after establishing mood stabilization.
本研究旨在测试拉莫三嗪在维持小儿双相情感障碍（PBD）躁狂和抑郁症状控制方面的有效性和安全性。
对46名患有躁狂或轻躁狂的受试者进行了为期14周的开放试验。拉莫三嗪在8周内缓慢滴定至治疗剂量，在此期间使用第二代抗精神病药物（SGA）稳定急性症状，随后进入为期6周的拉莫三嗪单药治疗阶段。
在14周的终点，躁狂症状（青年躁狂评定量表[YMRS]<12）的缓解率为72%，抑郁症状（儿童抑郁评定量表修订版[CDRS-R]<40）的缓解率为82%，平均终点拉莫三嗪剂量为1.8mg/磅时缓解率为56%。在拉莫三嗪维持阶段，抑郁症状进一步减轻。6.4%的患者出现良性皮疹。在8周时缓解的受试者中，有3名受试者（23%）在第14周前复发。
拉莫三嗪单药治疗似乎对维持PBD的躁狂和抑郁症状控制有效，且不良反应最小，尽管需要未来的双盲对照试验来证实这一发现。拉莫三嗪治疗的起始时机可以在急性疾病期间，并且在建立情绪稳定后可以维持症状控制。
