Q: Lamictal & Varying
It appears that some of the enthusiasm for Lamictal may be
diminishing, as reflected in the changes in the new (forthcoming) APA
Guidelines. See, e.g., http://www.mcmanweb.com/treating_bipolar_depression.html
be very interested in any thoughts that you might have regarding (1) these
changes in the Guidelines, and (2) relatedly, the recent studies that seem to
raise questions concerning Lamictal's effectiveness.
these questions not simply as a matter of curiosity. I was recently prescribed
lithium for bipolar depression (in addition to the Wellbutrin that I have long
been taking), I have had significant problems with resulting "side effects"
(mental fogginess, memory problems, etc.), and so I have been considering
Lamictal as an alternative.
Thank you very much in advance for any information and
insight that you might be able to provide in regard to all of this.
Two studies have appeared recently that I think are the basis for this confusion
about how effective lamotrigine (Lamictal) really is.
line: for patients who are more severely depressed when they enter a research
study, lamotrigine is consistently found to be more effective than a placebo.
The results are crystal clear on this, as can be seen in a single graph to which
I will leave you in a moment.
comparison, when lamotrigine is used in patients who are not as severely
depressed, but the results are not so clear. Indeed, a rigorous interpretation
would suggest that lamotrigine is no better than a placebo in such patients.
you add all the patients together, in these studies -- the less depressed as
well as the more severely depressed -- lamotrigine still looks better than a
placebo, but not by much.
For the two
studies in question, and the graph which displays all those findings described
above, here is a link that attempts a translation of these two "meta-analyses":
Does Lamotrigine Work, or Not? Don't get too lost in the details, if
you find them overwhelming. If necessary, just
skip to the more important, more recent of these two studies.
I think that what you are seeing in the varying Treatment Guidelines being
published recently is a varying expectation for "sufficient evidence", rather
than a varying view of what the medication actually does. In other words, some
treatment guideline authors have set the bar much higher for official evidence
of a medication's effectiveness than other authors (including the older Texas
Medical Algorithm, which put lamotrigine very high, but then was questioned in
the McMan article you linked).
the important question.
Published June, 2009