ADDITION OF LAMOTRIGINE TO VALPROATE MAY ENHANCE EFFICACY IN THE TREATMENT OF BIPOLAR AFFECTIVE-DISORDER

The new antiepileptic drug lamotrigine has been shown to be effective in the treatment of focal epilepsies with or without secondary general ization and has also been suggested to be efficacious in the treatment and prophylaxis of affective disorders. Therefore, we analyzed its po ssible benefit in a patient with refractory bipolar affective disorder . Lamotrigine (up to 150 mg/d) was added to valproate (2700 mg/d), sub stituting previously administered neuroleptics. A considerable improve ment of the patient's condition was achieved several days after the be ginning of lamotrigine co-administration, and lasted over the total fo llowup period of more than one year. The plasma concentrations after t otal remission were in the range of 1.9 to 6.2 mg/l for lamotrigine an d 57.1 to 95.2 mg/l for valproate. This positive action of lamotrigine is discussed in the context of the drug's elementary effects on sodiu m and calcium channels.