Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
J Clin Psychiatry. 2013 Jul;74(7):675-84. doi: 10.4088/JCP.12r08046.
Owing to the prevalence of medication side effects and treatment resistance, prescribers often consider off-label uses of US Food and Drug Administration (FDA)-approved agents for the treatment of persistent symptoms. The authors review the available literature on the FDA-approved and non-FDA-approved uses of lamotrigine in adults with psychiatric disorders.
We used PubMed, MEDLINE, and a hand search of relevant literature to find studies published between 1990 and 2012 and available in English language. The following keywords were searched: lamotrigine, psychiatric, mood disorders, depression, personality disorders, anxiety, schizophrenia, side effects, and rash.
Data were selected from 29 randomized controlled trials (RCTs). When RCTs were not available, open-label trials (6), retrospective case reviews (10), and case series (4) were summarized.
We extracted results of monotherapy and augmentation trials of lamotrigine on primary and secondary outcome measures.
Lamotrigine is generally well tolerated, with the best evidence for the maintenance treatment of bipolar disorder, particularly in prevention of depressive episodes. In acute bipolar depression, meta-analyses suggested a modest benefit, especially for more severely depressed subjects, with switch rates similar to placebo. In unipolar depression, double-blind RCTs noted benefit on subsets of symptoms and improved response in more severely depressed subjects. Data are limited but promising in borderline personality disorder. Use of lamotrigine in schizophrenia and anxiety disorders has little supportive evidence.
Lamotrigine is recommended in bipolar maintenance when depression is prominent. It also has a role in treating acute bipolar depression and unipolar depression, though the latter warrants more research. Data are too limited in other psychiatric disorders to recommend its use at this time.
由于药物副作用和治疗抵抗的普遍性，医生通常会考虑将美国食品和药物管理局 (FDA) 批准的药物用于治疗持续性症状的标签外用途。作者综述了 FDA 批准和非 FDA 批准的拉莫三嗪在成人精神障碍中的使用的相关文献。
我们使用 PubMed、MEDLINE 和相关文献的手工检索，查找了 1990 年至 2012 年间发表的英文文献。使用了以下关键词：拉莫三嗪、精神科、心境障碍、抑郁、人格障碍、焦虑、精神分裂症、副作用和皮疹。
数据来自 29 项随机对照试验 (RCT)。当 RCT 不可用时，总结了开放标签试验 (6)、回顾性病例综述 (10) 和病例系列 (4)。
我们提取了拉莫三嗪单药和增效治疗的主要和次要结局指标的结果。
拉莫三嗪通常具有良好的耐受性，在维持治疗双相障碍方面证据最好，特别是预防抑郁发作。在急性双相抑郁中，荟萃分析表明有适度的益处，尤其是对抑郁程度更严重的患者，与安慰剂的转换率相似。在单相抑郁中，双盲 RCT 指出对某些症状有好处，并改善了抑郁程度更严重的患者的反应。在边缘型人格障碍中的数据有限，但有希望。拉莫三嗪在精神分裂症和焦虑障碍中的应用证据不足。
在抑郁明显时，拉莫三嗪推荐用于双相维持治疗。它在治疗急性双相抑郁和单相抑郁方面也有作用，但后者需要更多的研究。在其他精神障碍中，数据有限，目前不推荐使用。
