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lamotrigine dose and bipolar

Meng Sun, Pan Huang, Yan Wang, Weihai Chen
Maternal behavior is a highly motivated and well-organized social behavior. Previous studies have reported that anticonvulsants are frequently used in postpartum bipolar disorder. However, the maternal disruptive effect of the anticonvulsants has not been explored. The purpose of the present study was to examine the effect of anticonvulsants lamotrigine and riluzole on maternal behavior in postpartum female rats. On postpartum Day 3, Sprague-Dawley mother rats were given a single intraperitoneal injection of vehicle, lamotrigine (15, 25, 35 mg/kg), or riluzole (2, 4, 8 mg/kg)...
March 20, 2018: Pharmacology, Biochemistry, and Behavior
Shoko Kagawa, Kazuo Mihara, Takeshi Suzuki, Goyo Nagai, Akifumi Nakamura, Kenji Nemoto, Tsuyoshi Kondo
BACKGROUND/AIMS: Serum levels of brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) were prospectively monitored in relation with therapeutic response to lamotrigine augmentation therapy in 46 (15 males and 31 females) inpatients with treatment-resistant depressive disorder during an 8-week treatment with lamotrigine using an open-study design. METHODS: The subjects were 46 depressed patients who had already shown insufficient response to at least 3 psychotropics including antidepressants, mood stabilizers, and atypical antipsychotics...
2017: Neuropsychobiology
Sonia Hernandez-Diaz, Krista F Huybrechts, Rishi J Desai, Jacqueline M Cohen, Helen Mogun, Page B Pennell, Brian T Bateman, Elisabetta Patorno
OBJECTIVE: To assess the relative risk of oral clefts associated with maternal use of high and low doses of topiramate during the first trimester for epilepsy and nonepilepsy indications. METHODS: This population-based study nested in the US 2000-2010 Medicaid Analytic eXtract included a cohort of 1,360,101 pregnant women with a live-born infant enrolled in Medicaid from 3 months before conception through 1 month after delivery. Oral clefts were defined as the presence of a recorded diagnosis in claims during the first 90 days after birth...
January 23, 2018: Neurology
G Munch, N Godart
INTRODUCTION: Adolescence is a unique phase of the human developmental process. In adolescents, psychotropic medications may have different efficacy and tolerance profiles compared to those at other stages of the lifespan. Mood stabilizers are a complex pharmacological category including lithium, some anticonvulsants, and some second generation antipsychotics. Focusing on this class of pharmacological agents, we aim to answer the following questions: in which indications and according to which modalities should mood stabilizers be prescribed during adolescence? METHODS: Information was sought from the websites of the French Haute Autorité de santé (HAS) and Agence nationale de sécurité du médicament et des produits de santé (ANSM), the American Food and Drug Administration (FDA) and the British National Institute for Health and Clinical Excellence (NICE)...
October 2017: L'Encéphale
Nils Eiel Steen, Monica Aas, Carmen Simonsen, Ingrid Dieset, Martin Tesli, Mari Nerhus, Erlend Gardsjord, Ragni Mørch, Ingrid Agartz, Ingrid Melle, Anja Vaskinn, Olav Spigset, Ole A Andreassen
BACKGROUND: Mood stabilizers like lithium and anticonvulsants are used in bipolar and related psychotic disorders. There is a lack of knowledge of the relationship of these medications and cognition in the psychosis spectrum. We studied the association between serum concentration of mood stabilizers and cognitive performance in a well-characterized sample of bipolar and schizophrenia spectrum disorders. METHODS: Serum concentrations of valproate, lamotrigine, and lithium were analyzed for associations to performance on neuropsychological tests in six cognitive domains in individuals with bipolar disorder (n = 167) and in a combined sample of individuals with bipolar or schizophrenia spectrum disorders (n = 217)...
December 2016: International Journal of Bipolar Disorders
Spencer Levesque, Caylin Riley
We present the case of two healthy infants born to a bipolar female maintained on low-dose lamotrigine and quetiapine.
February 2017: Archives of Women's Mental Health
Isabella Pacchiarotti, Jordi León-Caballero, Andrea Murru, Norma Verdolini, Maria Antonietta Furio, Corinna Pancheri, Marc Valentí, Ludovic Samalin, Eva Solé Roigé, Ana González-Pinto, Jose Manuel Montes, Antonio Benabarre, Jose Manuel Crespo, Consuelo de Dios Perrino, Jose Manuel Goikolea, Luis Gutiérrez-Rojas, André F Carvalho, Eduard Vieta
Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants...
October 2016: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
Rintaro Sogawa, Sakiko Mochinaga, Takayoshi Inaba, Jun Matsushima, Yoshito Mizoguchi, Toshiro Kawashima, Hiroshi Fujito, Akira Monji
OBJECTIVES: Lamotrigine (LTG) is a drug commonly used to treat epilepsy and can also be used to manage mood disorders, such as bipolar disorder. One of the most dangerous adverse effects of LTG is skin rash, which can make early cessation necessary. Here, we examine the adverse effects associated with long-term use of LTG for the treatment of mood disorders. METHODS: Data were obtained from the medical records of 101 psychiatric patients who were prescribed long-term treatment with LTG...
November 2016: Clinical Neuropharmacology
Martin Alda, Margaret McKinnon, Ryan Blagdon, Julie Garnham, Susan MacLellan, Claire O'Donovan, Tomas Hajek, Cynthia Nair, Serdar Dursun, Glenda MacQueen
BACKGROUND: Residual symptoms and cognitive impairment are among important sources of disability in patients with bipolar disorder. Methylene blue could improve such symptoms because of its potential neuroprotective effects. AIMS: We conducted a double-blind crossover study of a low dose (15 mg, 'placebo') and an active dose (195 mg) of methylene blue in patients with bipolar disorder treated with lamotrigine. METHOD: Thirty-seven participants were enrolled in a 6-month trial (trial registration: NCT00214877)...
January 2017: British Journal of Psychiatry: the Journal of Mental Science
K Kamei, T Terao, Y Katayama, K Hatano, K Kodama, M Shirahama, A Sakai, H Hirakawa, Y Mizokami, I Shiotsuki, N Ishii, Y Inoue
Introduction: Lamotrigine is one of several mood stabilizers and its effects for the treatment and prevention of depressive episodes, particularly in bipolar disorder, are generally accepted. Although the findings about a therapeutic window of lamotrigine are yet to be determined, it seems important to obtain information on individual pharmacokinetic peculiarities. This study was conducted to formulate the predictive model of plasma lamotrigine levels. Methods: Using the data of 47 patients whose lamotrigine levels, liver function, and renal function were measured, predictive models of lamotrigine levels were formulated by stepwise multiple regression analyses...
September 2016: Pharmacopsychiatry
Akifumi Nakamura, Kazuo Mihara, Goyo Nagai, Shoko Kagawa, Takeshi Suzuki, Kenji Nemoto, Tsuyoshi Kondo
BACKGROUND: The authors have previously shown that an early therapeutic response to lamotrigine augmentation therapy is dependent on its plasma concentration and that a plasma lamotrigine concentration of 12.7 μmol/L may be a threshold for a good therapeutic response in treatment-resistant depressive disorder. The present study investigated whether or not an optimal dose of lamotrigine could be predicted from plasma lamotrigine concentration at week 2. METHODS: The subjects were 37 depressed patients who had already shown insufficient response to at least 3 psychotropics including antidepressants, mood stabilizers, and atypical antipsychotics...
June 2016: Therapeutic Drug Monitoring
Luana D Laurito, Leonardo F Fontenelle, David A Kahn
Although some studies have reported a relationship between hoarding and bipolar disorder, we are unaware of any previous description of how they may interact with each other and how they should be managed appropriately. A 48-year-old male depressed patient with hoarding symptoms and obsessive-compulsive disorder (OCD) was diagnosed with bipolar II disorder after 2 hypomanic episodes. The patient was treated unsuccessfully with different high-dose serotonin reuptake inhibitors and atypical antipsychotics, maintaining a pattern of 6 to 8 discrete, but severe, depressive episodes each year, always in association with a drastic worsening of his OCD and hoarding symptoms...
January 2016: Journal of Psychiatric Practice
Robert L Findling, Kiki Chang, Adelaide Robb, Vicki J Foster, Joseph Horrigan, Alok Krishen, Art Wamil, John E Kraus, Melissa DelBello
OBJECTIVE: This study aimed to compare the efficacy of lamotrigine versus placebo in 10- to 17-year-olds with bipolar I disorder (BP-I) who were receiving conventional bipolar disorder treatment. METHOD: In this randomized withdrawal trial, patients with BP-I of at least moderate severity received lamotrigine during an ≤18-week open-label phase. Patients who maintained a stable lamotrigine dose for ≥2 weeks and Clinical Global Impression-Bipolar Severity of Illness (CGI-BP[S]) score of ≤3 for ≥6 consecutive weeks were randomized to double-blind lamotrigine or placebo for ≤36 weeks...
December 2015: Journal of the American Academy of Child and Adolescent Psychiatry
Michael B Centorino, Glenn Catalano, Maria C Catalano
Lamotrigine is an anticonvulsant medication that also has utility in the treatment of bipolar disorder. It has been associated with many side effects, including rashes that can progress to Stevens-Johnson syndrome or toxic epidermal necrolysis. It has also been associated with the development of motor tics, most commonly in the head, neck, and shoulders. We will now present the case of a 45-year-old woman who developed tics that involved the entire left side of her body after her dose of lamotrigine was increased from 200 mg daily (2...
2016: Current Drug Safety
Milena Pereira Pondé, Antonio Carlos Cruz Freire
Introduction. Akathisia affects around 18% of patients with bipolar disorder treated with aripiprazole and may worsen when aripiprazole is combined with lamotrigine and antidepressants. Case. This paper reports on two clinical cases involving patients with a diagnosis of mood disorder who developed severe akathisia, anxiety, and suicidal ideation while using a combination of aripiprazole, antidepressants, and lamotrigine. Discussion. We recommend that patients with a mood disorder taking multiple drugs should begin aripiprazole therapy with low doses and be monitored for the development of akathisia, increased anxiety, or suicidal thoughts...
2015: Case Reports in Psychiatry
S Unholzer, E Haen
INTRODUCTION: Lamotrigine is licensed for treatment of epilepsy and prevention or at least delay of depressive episodes in bipolar disorder. The accepted therapeutic reference range (TRR) of lamotrigine for anticonvulsant treatment is 3 000-14 000 ng/ml. This TRR is often used for the therapy of bipolar disorders as well. This work presents serious doubts about this approach. METHODS: KONBEST, a large TDM database containing patients' characteristics including diagnoses, doses, comedication and serum concentrations, was analyzed...
September 2015: Pharmacopsychiatry
Hoo Rim Song, Young-Joon Kwon, Won-Myong Bahk, Young Sup Woo, Hwang-Bin Lee, Jonghun Lee, Dae-Bo Lee, Sang-Yeol Lee, Moon-Doo Kim, Seunghee Won, Kwanghun Lee, Inki Sohn, Jung Goo Lee, Young-Chul Shin, Sangkeun Chung, Saeheon Jang, Young Myo Jae, Bo-Hyun Yoon
AIMS: We examined prescription patterns in maintenance treatment for recovered bipolar patients and compared these with acute treatments. METHODS: Using retrospective methods, the bipolar patients in clinical recovery (Clinical Global Impression Bipolar Version score ≤ 2 for 6 months) after acute episode were selected. We reviewed differences between prescription patterns at remission and after a maintenance period of at least 6 months. RESULTS: A total of 340 bipolar disorder patients were selected...
January 2016: Psychiatry and Clinical Neurosciences
Andrea Murru, Dina Popovic, Isabella Pacchiarotti, Diego Hidalgo, Jordi León-Caballero, Eduard Vieta
Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs...
August 2015: Current Psychiatry Reports
Jose de Leon
The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects...
April 2015: Revista de Psiquiatrí́a y Salud Mental
Shoko Kagawa, Kazuo Mihara, Akifumi Nakamura, Kenji Nemoto, Takeshi Suzuki, Goyo Nagai, Tsuyoshi Kondo
BACKGROUND: The relationship between plasma concentrations of lamotrigine and its therapeutic effects was prospectively studied on 34 (9 men and 25 women) inpatients with treatment-resistant depressive disorder during an 8-week treatment of lamotrigine augmentation using an open-study design. METHODS: The subjects were depressed patients who had already shown insufficient response to at least 3 psychotropics, including antidepressants, mood stabilizers, and atypical antipsychotics...
December 2014: Therapeutic Drug Monitoring
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