Combining Meds for Bipolar Disorder

Rapid cycling bipolar disorder was not helped by Lamictal when it was added to other drugs

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) People with rapid cycling bipolar disorder may have different treatments needs. A recent study looked at combining Depakote, lithium and Lamictal.

These researchers first tried to stabilize people with rapid cycling bipolar disorder on Depakote plus lithium.  When they added Lamictal to see if that would help with depression, it didn’t.

They found that adding Lamictal did not help these patients to move out of their depression.

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For many people with bipolar disorder, the mood shifts to mania or depression happen only a couple times a year. Each cycle lasts a month or more. People with rapid cycling bipolar disorder have at least four mood shifts in a year. So, their shifts happen more often and last for a shorter time.

Researchers, led by David Kemp, MD, of the Department of Psychiatry at the University Hospitals Case Medical Center of Case Western Reserve University in Cleveland, looked at how people with rapid cycling bipolar disorder responded to some common medications.

In the first phase of the study, they enrolled 133 adult patients. They started them on a combination of Depakote (divalproex) and lithium for 16 weeks.

In phase one, they found that 49 people did not respond well to the drugs – they were still depressed or became depressed.

So those 49 people were divided into two groups. One group added Lamictal (lamotrigine) for 12 weeks. The other group added a placebo, or sugar pill.

The authors also noted that during phase one, 10 percent of the people dropped out of the study because of the side effects of lithium plus Depakote.

It was not clear if it was the lithium, Depakote or the combination that caused the high dropout rate.

The authors concluded that adding Lamictal was not helpful for patients who didn't come out of their depression after taking Depakote plus lithium.

However, this study looked at a very small group of people who were rapid cycling and did not respond to the initial treatment of Depakote plus lithium.

Both Lamictal and Depakote were originally used to treat seizures. They are both used for bipolar because they show some mood stabilizing effects. 

This study was published October 29 in Bipolar Disorders. The study was funded by grants from the National Institute of Mental Health and the Stanley Medical Research Institute.

Authors on this study report financial interests with a variety of pharmaceutical companies including but not limited to: Bristol-Meyers Squibb, Pfizer, Abbot, AstraZeneca and Eli Lilly.

Reviewed by: 
Review Date: 
November 17, 2012
Last Updated:
November 26, 2012