The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Expert Opin Pharmacother. 2012 Dec;13(17):2565-71. doi: 10.1517/14656566.2012.741590.
Over the past decade the use of lamotrigine in bipolar disorder has increased. However, the evidence base suggests a more limited role for lamotrigine as part of an overall treatment regimen in bipolar disorder.
We reviewed publications of randomized clinical trials of lamotrigine, emphasizing studies in bipolar disorder. The low burden of adverse effects with lamotrigine has been confirmed in these studies. Its lack of benefit in acute mania is established. Despite modest benefits for a subset of depressive episodes in bipolar disorder, it was not superior to placebo in well-designed studies. As monotherapy, in randomized, blinded trials in rapid cycling bipolar disorder it was not superior to placebo. Its role in maintenance treatment is relatively well established as one component of combination therapy, with evidence for benefits when combined with lithium or valproate. Combination regimens including lamotrigine appear to be superior to monotherapy. Monotherapy utilization of lamotrigine for maintenance treatment is not supported by these studies.
Lamotrigine has benefits in bipolar disorder management principally as a component of combination treatment which includes a mood stabilizer. The utility of lamotrigine in acute bipolar depression and major depressive disorder is modest.
在过去的十年中，拉莫三嗪在双相情感障碍中的应用有所增加。然而，证据基础表明，拉莫三嗪作为双相情感障碍整体治疗方案的一部分的作用更为有限。
我们回顾了拉莫三嗪随机临床试验的出版物，重点是双相情感障碍的研究。这些研究证实了拉莫三嗪的不良反应负担低。它在急性躁狂症中没有益处。尽管在双相情感障碍的部分抑郁发作中有适度的益处，但它在设计良好的研究中并不优于安慰剂。作为单药治疗，在快速循环双相情感障碍的随机、盲法试验中，它并不优于安慰剂。作为联合治疗的一部分，其在维持治疗中的作用相对明确，与联合锂或丙戊酸盐的疗效证据一致。包括拉莫三嗪的联合治疗方案似乎优于单药治疗。这些研究不支持将拉莫三嗪作为单药治疗用于维持治疗。
拉莫三嗪在双相情感障碍管理中的益处主要是作为联合治疗的一部分，包括心境稳定剂。拉莫三嗪在急性双相抑郁和重性抑郁症中的疗效有限。
