Fatemi S H, Rapport D J, Calabrese J R, Thuras P
Department of Psychiatry, University of Minnesota, Minneapolis, USA.
J Clin Psychiatry. 1997 Dec;58(12):522-7. doi: 10.4088/jcp.v58n1202.
We evaluated the antidepressant and mood-stabilizing effects of lamotrigine, a novel anticonvulsant, in a group of rapid-cycling bipolar patients. Most were already nonresponders or poor partial responders to other conventional mood-stabilizing agents.
This open, naturalistic, and prospective study was conducted with five rapid-cycling bipolar patients (DSM-IV). Each received lamotrigine titrated to a minimum dose of 150 mg/day as monotherapy or in combination with other psychotropic agents. Patients were assessed with the Global Assessment Scale (GAS), Beck Depression Inventory (BDI), and Young Mania Rating Scale (YMRS) for evidence of cycling mood.
Lamotrigine was used at a mean +/- SD dose of 185.0 +/- 33.5 mg/day for 225.8 +/- 28.0 days. Random regression modeling of data showed significant dose- and time-dependent improvements in depressive symptoms and social function of patients taking lamotrigine (Dose: z = 2.17, p < .03 for BDI, z = 4.44, p < .001 for GAS; Time: z = -3.79, p < .001 for BDI, z = 2.16, p < .03 for GAS). Further random regression modeling analysis of change over time in symptoms prior to lamotrigine compared with symptoms during lamotrigine treatment showed a significant treatment by time effect for GAS (z = 2.40, p < .016) and a trend for BDI scores (z = -1.79, p < .073). No significant time or dosage effect or time by treatment effect was observed for YMRS. Finally, t statistics showed a significant reduction in mean BDI scores following treatment with lamotrigine (t = -5.26, p < .006). Lamotrigine was well tolerated by all patients; only one patient experienced several side effects, which were probably due to interaction between several psychotropic medications.
Lamotrigine augmentation therapy and monotherapy appeared to have mood-stabilizing and antidepressant efficacy in the treatment of five rapid-cycling bipolar patients. The effect persisted for an average of 7.5 months.
我们评估了新型抗惊厥药物拉莫三嗪对一组快速循环型双相情感障碍患者的抗抑郁和心境稳定作用。这些患者大多对其他传统心境稳定剂无反应或反应不佳。
对5名快速循环型双相情感障碍患者（DSM-IV）进行了这项开放性、自然主义的前瞻性研究。每位患者接受拉莫三嗪治疗，滴定至最低剂量150毫克/天，作为单一疗法或与其他精神药物联合使用。使用全球评估量表（GAS）、贝克抑郁量表（BDI）和杨氏躁狂评定量表（YMRS）对患者进行评估，以确定是否存在心境循环的证据。
拉莫三嗪的平均剂量为185.0±33.5毫克/天，使用时间为225.8±28.0天。对数据进行随机回归建模显示，服用拉莫三嗪的患者在抑郁症状和社会功能方面有显著的剂量和时间依赖性改善（剂量：BDI的z值=2.17，p<.03；GAS的z值=4.44，p<.001；时间：BDI的z值=-3.79，p<.001；GAS的z值=2.16，p<.03）。与拉莫三嗪治疗期间的症状相比，对拉莫三嗪治疗前症状随时间变化的进一步随机回归建模分析显示，GAS有显著的治疗时间效应（z=2.40，p<.016），BDI评分有趋势性变化（z=-1.79，p<.073）。YMRS未观察到显著的时间或剂量效应或治疗时间效应。最后，t检验显示拉莫三嗪治疗后平均BDI评分显著降低（t=-5.26，p<.006）。所有患者对拉莫三嗪耐受性良好；只有一名患者出现了几种副作用，可能是由于几种精神药物之间的相互作用。
拉莫三嗪增效疗法和单一疗法在治疗5名快速循环型双相情感障碍患者中似乎具有心境稳定和抗抑郁疗效。这种效果平均持续7.5个月。
