Lamotrigine and mania prevention

[Psychferlyfe3000]

Is Goodwin et al's 2004 pooled analysis paper the best evidence we have to answer the question of whether or not lamotrigine prolongs time until next manic episode? I keep seeing sources that cite the individual papers that compose this pooled analysis after which they draw the conclusion that lamotrigine does NOT prevent mania. I am unsure why they gloss over the pooled analysis paper.

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[Evidence Based]

Really curious about this as well. My clinic has a lot of people with a dx of bipolar II on lamotrigine montherapy as a "mood stabilizer," although I'm not aware of evidence it's prophylactic against mania. To be frank, my heuristic is usually that these patients either:
A) Would be more accurately diagnosed w/ personality disorder (usually BPD) rather than bipolar and lamotrigine is seen as helpful for "affective lability"
B) May have had a mixed episode in the past but no frank mania (less common than A)

 

[MacDonaldTriad]

I think it is fairly well accepted that lamotrigine doesn't prevent Mania. I have heard Goodwin himself say that he would like to market a combo drug of LiCo3 and Lamictal, He joked he would call it Lithictal.

 

[the5thelement]

What if the mania was really hypomania?

 

[MacDonaldTriad]

I think the distinction between bipolar I and bipolar II is a good example of forcing continuous variables into a discreet paradigm. One of the criteria for hypomania is that it isn't severe enough to require hospitalization. I'm fairly sure what ever the neuropathophysiology if that creates mania isn't aware of insurance status and all of the other variables that go into the decision to hospitalize or not. I would be very surprised is a drug that doesn't work on mania would be found to work on hypomania.

 

[clozareal]

The CANMAT 2018 guidelines seem to think lamotrigine has good data for prevention of mania/hypomania relapse. Calabrese has a post-hoc analysis in 2006 suggesting this. There's also a 2014 network meta-analysis paper by Miura in The Lancet Psychiatry that also reported that lamotrigine was effective against mood relapses.

Lamictal has an interesting history about how its birth that was recently highlighted in a Carlat Report podcast episode. GSK submitted 12 trials of Lamictal that only had two studies with significant effect (maintenance only, failed acute mania/depression/rapid cycling), but in those studies it more than doubled the time to the next mood episode compared to placebo (197 days vs. 86 days).

The Birth of Lamotrigine

Richard Weisler tells the tale of science and serendipity that lead to his discovery of lamotrigine for bipolar depression 30 years ago. He shares a few dosing tips, and touches on how he works with patients and their families. Plus, the word of the day: Gramophone Syndrome.Published On...

www.thecarlatreport.com

 

[Psychferlyfe3000]

The CANMAT 2018 guidelines seem to think lamotrigine has good data for prevention of mania/hypomania relapse. Calabrese has a post-hoc analysis in 2006 suggesting this. There's also a 2014 network meta-analysis paper by Miura in The Lancet Psychiatry that also reported that lamotrigine was effective against mood relapses.

Lamictal has an interesting history about how its birth that was recently highlighted in a Carlat Report podcast episode. GSK submitted 12 trials of Lamictal that only had two studies with significant effect (maintenance only, failed acute mania/depression/rapid cycling), but in those studies it more than doubled the time to the next mood episode compared to placebo (197 days vs. 86 days).

The Birth of Lamotrigine

Richard Weisler tells the tale of science and serendipity that lead to his discovery of lamotrigine for bipolar depression 30 years ago. He shares a few dosing tips, and touches on how he works with patients and their families. Plus, the word of the day: Gramophone Syndrome.Published On...

www.thecarlatreport.com

Ah, okay! Thank you for those paper suggestions. Honestly had forgotten about that Carlat episode. Love that podcast.