An open longitudinal study of patients with bipolar rapid cycling treated with lithium or lamotrigine for mood stabilization

Objectives: Patients with rapid cycling bipolar disorder are frequently; ob served to fail conventional treatment. We conducted a preliminary study to explore the potential efficacy of lamotrigine in the treatment of this refr actory patient population. Methods: In an open longitudinal investigation, 14 patients with rapid cycl ing bipolar disorder were treated for 1 year with either lithium or lamotri gine as mood stabilizer. Results: Out of the seven patients with lithium, three out of ses en (43%) had less than four and four out Of seven (57%) had four or more episodes. I n the lamotrigine group, sis out of seven (86%) had less than four and one out of seven (14%) had more than four affective episodes (depressive, manic , hypomanic or mixed). In fact, three out of seven (43%) of the patients wh o were on lamotrigine therapy were without any further affective episodes. There was no evidence of a preferential antidepressant versus antimanic eff icacy. Conclusions: Although the study is limited bq: the small number of patients , the results are in line with other investigations, suggesting efficacy; f or lamotrigine and a suboptimal response for lithium in rapid cycling bipol ar disorder. These preliminary data need to be confirmed with controlled do uble blind studies.