Lamotrigine Update and its Use in Mood Disorders

2002 ◽  
Vol 36 (5) ◽  
pp. 860-873 ◽  
Author(s):  
Stephen C Hurley
Keyword(s):  
Valproic Acid ◽  
Clinical Trials ◽  
Adverse Effects ◽  
Mood Disorders ◽  
Calcium Influx ◽  
Bipolar Depression ◽  
Response Rates ◽  
Dose Titration ◽  
Double Blind ◽  
Positive Effects

OBJECTIVE: To provide a qualitative, systematic update and review of the pharmacology, pharmacokinetics, efficacy in mood disorders, adverse effects, and costs of lamotrigine. DATA SOURCES: Citations obtained from MEDLINE searches (1985–September 2001) using lamotrigine as a text word, articles identified in reference lists of pertinent articles, abstracts presented at conferences, and research data from GlaxoSmithKline. DATA EXTRACTION: English-language articles were considered for possible inclusion. Each title and abstract was examined to determine whether the publication contained up-to-date information relevant to the objective. Twenty clinical trials that provided data on response rates in mood disorders were tabulated. DATA SYNTHESIS: Lamotrigine's primary action is to modulate voltage-gated sodium channels. Evidence suggests that it decreases glutamate transmission, directly reduces calcium influx, mildly blocks transmitter reuptake, and alters intracellular mechanisms of resting transmitter release. The average half-life of lamotrigine is approximately 24 hours, but decreases to approximately 7.4 hours when used concurrently with phenytoin, and increases to approximately 59 hours with valproic acid. Seven of the 20 clinical trials were randomized, double-blind, and controlled. Existing data are inadequate to evaluate lamotrigine use in major depression. The pooled response rates for patients with depressed, manic, mixed, and rapid cycling bipolar disorder were similar, ranging from 52% to 63%. Adverse effects are infrequent when the drug is used alone, but become more frequent when lamotrigine is combined with other anticonvulsants. While most rashes are mild, approximately 1 in 500 patients develops exfoliative dermatitis. A slow upward dose titration is recommended to reduce the incidence of serious rash, but this may delay the attainment of adequate dosage for 6 weeks. Lamotrigine has positive effects on cognitive function, but occasionally produces insomnia. Lamotrigine costs 2–4 × more than lithium, carbamazepine, and generic valproic acid. CONCLUSIONS: When efficacy, adverse effects, and cost are considered, lamotrigine should probably be reserved as a second-line agent for bipolar depression.

Psychiatric Uses of Anticonvulsants

1990 ◽  
Vol 3 (4) ◽  
pp. 262-275 ◽  
Author(s):  
Peter G. Dorson
Keyword(s):  
Bipolar Disorder ◽  
Valproic Acid ◽  
Adverse Effects ◽  
Mood Disorders ◽  
Alcohol Withdrawal ◽  
Acute Treatment ◽  
Treatment Resistant ◽  
Double Blind ◽  
Dosage Guidelines ◽  
Third Line

Anticonvulsants are being used for psychiatric indications with increasing frequency. The potential indications for carbamazepine (CBZ), valproic acid (VPA), clonazepam, and phenytoin are reviewed, with emphasis on double-blind controlled studies where available. Dosage guidelines, adverse effects, and monitoring parameters are reviewed for each of these drugs. The pathophysiological basis for anticonvulsant effectiveness is presented for mood disorders and aggression. CBZ and VPA represent second and third line agents after traditional lithium therapy in bipolar disorder. Clonazepam may be effective in the acute treatment of manic agitation. These alternative agents, when used for appropriate indications, may help the clinician manage the treatment-resistant manic patient. CBZ is also effective for the treatment of aggression and potentially effective for alcohol withdrawal.

scholarly journals Medicinal herbs with anti-depressant effects

2020 ◽  
Vol 9 (4) ◽  
pp. 309-317 ◽  
Author(s):  
Mahbubeh Setorki
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
Complete Recovery ◽  
Medicinal Herbs ◽  
Double Blind ◽  
Synthetic Drugs ◽  
Positive Effects ◽  
Antidepressant Effects ◽  
Life Threatening ◽  
Echium Amoenum

Depression is a life-threatening chronic illness which affects people worldwide. Drugs used to treat this disease have multiple side effects and may cause drug-drug or drug-food interactions. Additionally, only 30% of patients respond adequately to the existing drugs and the remaining do not achieve complete recovery. Thus, finding effective treatments that have adequate efficacy, fewer side effects and lower cost seem to be necessary. The purpose of this study was to review animal and double-blind clinical studies on the anti-depressant effects of medicinal herbs. In this study, validated scientific articles indexed in PubMed, SID, Web of Science and Scopus databases were reviewed. A database search was performed using the following terms: clinical trials, depression, major depressive disorder, essential oil, extract and medicinal plant. Positive effects of a number of herbs and their active compounds such as St John’s-wort, saffron, turmeric, ginkgo, chamomile, valerian, Lavender, Echium amoenum and Rhodiola rosea L. in improvement of symptoms of mild, moderate or major depression have been shown in clinical trials. The above plants show antidepressant effects and have fewer side effects than synthetic drugs. Hence, they have the potential to treat patients with depression.

Homeopathic aggravations: a systematic review of randomised, placebo-controlled clinical trials

Homeopathy ◽  
2003 ◽  
Vol 92 (02) ◽  
pp. 92-98
Author(s):  
S Grabia ◽  
E Ernst
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Adverse Effects ◽  
Randomised Clinical Trials ◽  
Controlled Clinical Trials ◽  
Double Blind ◽  
Literature Searches

AbstractHomeopathic aggravations have often been described anecdotally. However, few attempts have been made to scientifically verify their existence. This systematic review aimed at comparing the frequency of homeopathic aggravations in the placebo and verum groups of double-blind, randomised clinical trials. Eight independent literature searches were carried out to identify all such trials mentioning either adverse effects or aggravations. All studies thus found were validated and data were extracted by both authors. Twenty-four trials could be included. The average number of aggravations was low. In total, 50 aggravations were attributed to patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies. We conclude that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.

Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials

2008 ◽  
Vol 10 (2) ◽  
pp. 323-333 ◽  
Author(s):  
Joseph R Calabrese ◽  
Russell F Huffman ◽  
Robin L White ◽  
Suzanne Edwards ◽  
Thomas R Thompson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Treatment ◽  
Bipolar Depression ◽  
Controlled Clinical Trials ◽  
Double Blind ◽  
Double Blind Placebo

Rifabutin: A Review with Emphasis on its Role in the Prevention of Disseminated Mycobacterium Avium Complex Infection

1994 ◽  
Vol 28 (11) ◽  
pp. 1250-1254 ◽  
Author(s):  
Daniel S. Maddix ◽  
Kimberly B. Tallian ◽  
Paul S. Mead
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Aids Patients ◽  
Double Blind ◽  
Medline Search ◽  
Cd4 Lymphocyte

OBJECTIVE: To discuss the mechanism of action, in vitro and in vivo activity, pharmacokinetics, clinical trials, adverse effects, drug interactions, and dosage guidelines of rifabutin. DATA SOURCES: Pertinent literature published between 1982 and 1993 was identified via a MEDLINE search. Published proceedings of selected conferences were also reviewed. STUDY SELECTION: Selected basic science, microbiologic, and pharmacokinetic articles were evaluated. Because only limited data regarding rifabutin were available in the literature, all clinical trials involving the use of rifabutin in the prevention of Mycobacterium avium complex (MAC) infection in AIDS patients were reviewed. DATA SYNTHESIS: Rifabutin is a rifamycin derivative that was approved recently for the prevention of disseminated MAC disease in patients with advanced HIV infection. The drug has in vitro and in vivo activity against gram-positive bacteria, gram-negative bacteria, and mycobacteria. Two prospective, randomized, double-blind, placebo-controlled, multicenter trials demonstrated that rifabutin decreased the progression to MAC bacteremia in AIDS patients by about 50 percent. Adverse effects that resulted in the discontinuation of rifabutin prophylaxis occurred in 16 percent of patients. Rifabutin induces hepatic enzymes to a lesser extent than does rifampin, but dosage adjustment of drugs that are known to interact with rifampin may be required. CONCLUSIONS: Rifabutin is the only drug shown to be effective in the prevention of MAC bacteremia in AIDS patients; therefore, it should be made available as a formulary agent. It may be reasonable to delay initiation of rifabutin prophylaxis until CD4 lymphocyte counts are less than 75–50/mm3.

scholarly journals Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial

2004 ◽  
Vol 34 (6) ◽  
pp. 973-982 ◽  
Author(s):  
J. J. S. KOOIJ ◽  
H. BURGER ◽  
A. M. BOONSTRA ◽  
P. D. VAN DER LINDEN ◽  
L. E. KALMA ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Response Rates ◽  
Dose Titration ◽  
Future Research ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Hyperactivity Disorder ◽  
Co Morbidity ◽  
The Impact

Background. Data on the efficacy and safety of methylphenidate in adults with attention deficit/hyperactivity disorder (ADHD) are lacking in Europe. This study was undertaken to report on the efficacy and safety of methylphenidate in an adult out-patient population with ADHD, and to compare results with US data.Method. A double-blind randomized cross-over trial comparing methylphenidate and placebo in 45 adults with ADHD with childhood onset was performed in a dose–titration design. Methylphenidate was titrated from 0·5 mg/kg per day in week 1 up to 1·0 mg/kg per day in week 3.Results. Response rates using methylphenidate varied between 38 and 51%, and using placebo between 7 and 18% (p<0·05), depending on outcome measure used. Although the overall percentage of subjects having any side effect on both methylphenidate and placebo was rather high, side effects on methylphenidate over and above those on placebo were few and mild.Conclusions. Methylphenidate proves to be an effective and well tolerated treatment for symptoms of ADHD in adults in the short term. Future research should study the long-term response and clarify the impact of gender, co-morbidity, socio-economic status and IQ on response rates in adults with ADHD.

scholarly journals Placebo and nocebo effects in the neurological practice

2015 ◽  
Vol 73 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Caroline Bittar ◽  
Osvaldo J.M. Nascimento
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Gold Standard ◽  
Neurological Diseases ◽  
Nocebo Effect ◽  
Double Blind ◽  
Positive Effects ◽  
Specific Effects ◽  
Randomized Clinical Study ◽  
Nocebo Effects

Knowledge of placebo and nocebo effects is essential to identify their influence on the results in clinical practice and clinical trials, and thereby properly interpret their results. It is known that the gold standard of clinical trials research is the double-blind, placebo-controlled, randomized clinical study. The objective of this review is to distinguish specific from non-specific effects, so that the presence of positive effects in the group that received placebo (placebo effect) and the presence of adverse effects in the group receiving placebo (nocebo effect) lead to confounding in interpreting the results. Placebo and nocebo effects have been considered in neurological diseases such as depression, pain, headache, multiple sclerosis, epilepsy. As placebo and nocebo effects are also present in clinical practice, the purpose of this review is to draw attention to their influence on neurological practice, calling attention to the development of measures that can minimize them.

Atovaquone: A Review with Emphasis on its Role in the Treatment of Pneumocystis Carinii Pneumonia

1994 ◽  
Vol 10 (4) ◽  
pp. 151-155
Author(s):  
Daniel S. Maddix
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Mechanism Of Action ◽  
Pneumocystis Carinii Pneumonia ◽  
Pneumocystis Carinii ◽  
Plasmodium Species ◽  
Double Blind ◽  
Medline Search

Objective: To discuss the mechanism of action, in vitro and in vivo activity, pharmacokinetics, clinical trials, adverse effects, drug interactions, and dosage guidelines of atovaquone. Data Sources: Pertinent literature published since 1988 was identified via a MEDLINE search. Published proceedings of selected conferences were also used. Study Selection: All basic science, microbiologic, and pharmacokinetic articles were evaluated. Since only limited data regarding atovaquone are available in the literature, all clinical trials involving the use of atovaquone in the treatment of Pneumocystis carinii pneumonia were reviewed. Data Synthesis: Atovaquone is an antiprotozoal agent that was recently approved for the treatment of mild to moderate P. carinii pneumonia (PCP) in patients who are intolerant of trimethoprim/sulfamethoxazole (TMP/SMX). The exact mechanism of action of atovaquone against P. carinii has not been determined. The drug has in vitro and in vivo activity against P. carinii, Toxoplasma gondii, and Plasmodium species. The bioavailability of oral atovaquone is highly variable. The drug must be administered with food to enhance absorption. In a double-blind comparative trial in AIDS patients with mild to moderate PCP, those who were treated with atovaquone had a significantly higher mortality rate than those treated with TMP/SMX. More patients who received TMP/SMX experienced adverse effects that resulted in discontinuation of therapy. Conclusions: Because of concerns of increased mortality in atovaquone recipients, the drug should be reserved for the treatment of mild to moderate PCP in patients who are unable to tolerate TMP/SMX and trimethoprim-dapsone.

Sertraline: A New Serotonin Reuptake Inhibitor

1992 ◽  
Vol 8 (6) ◽  
pp. 238-241 ◽  
Author(s):  
Sandra R. Tolbert ◽  
Matthew A. Fuller
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Sample Size ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Small Sample ◽  
Serotonin Reuptake Inhibitor ◽  
Double Blind ◽  
Compulsive Disorder ◽  
English Language Journal

Objective: Sertraline is a naphthylamine antidepressant. It is chemically unrelated to tricyclic, tetracyclic, or other available antidepressant agents. This article evaluates the published clinical trials of sertraline, a new serotonin reuptake inhibitor, for the treatment of depression and obsessive-compulsive disorder (OCD). Data Sources: English-language journal articles published between 1978 and 1990. Study Selection: Five studies comparing sertraline with placebo or amitriptyline were evaluated. All were short-term, double-blind, outpatient studies. Two double-blind, placebo-controlled trials evaluated sertraline in the treatment of OCD. Data Extraction: Studies were assessed for sample size, study design, duration of therapy, dosage, adverse effects, and results. Data Synthesis: Three of the five studies comparing sertraline with amitriptyline support its efficacy as an antidepressant. The remaining two trials compared placebo with sertraline and had conflicting results. Two studies evaluated sertraline in OCD. One study, which had a small sample size, produced negative results; however, the other study, evaluating a larger sample size, found sertraline to be superior to placebo. The most common adverse effects with sertraline were dry mouth, nausea, diarrhea, male sexual dysfunction, tremor, dyspepsia, and insomnia. The dosage range for sertraline is 50–200 mg, given once daily. Conclusions: The results from the clinical trials reviewed suggest that sertraline is an effective antidepressant with efficacy rates similar to amitriptyline. Sertraline appears to be a promising new antidepressant; however, further clinical trials with other tricyclics and serotonin reuptake inhibitors are warranted.

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