What is Bipolar Depression?
Bipolar depression is a mental illness characterized by atypical mood changes, energy swings and the ability to function. One more disorder name is manic-depressive psychosis. Unlike normal mood changes, with their ups and downs that are common to everyone, the symptoms of bipolar depression can lead to very serious consequences. They are able to destroy personal relationships, affect the quality of work or school performance, and even lead to suicide.
Bipolar Depression and Anxiety Treatment with Lamictal (Lamotrigine)
All the main anticonvulsants used normosmic, namely Carbamazepine, Valproate and Lamotrigine (Lamictal), to some extent affect all of the above mechanisms, contributing to:
- increase in the density of interneuronal contacts in brain regions;
- increasing the concentration of the main neurotrophic brain factors;
- improvement of receptor reactions (activation of adenylate cyclase and protein kinase);
- suppression of excessive activation of ion channels of neuronal membranes.
An interesting fact is that despite the various ways of implementing the antiepileptic activity of these anticonvulsants, their neuroplastic and neuroprotective mechanisms of action on the CNS, which determine the efficacy, are quite close. However, the clinical effects of these agents and, accordingly, the scope of their use in bipolar disorder are significantly different. It indicates the presence of yet unidentified relationships between the points of application of anticonvulsants at the molecular level and their effect on manic and depressive symptoms in this pathology. Establishing these relationships will further optimize the pharmacotherapy of BAR.
How does Lamictal (Lamotrigine) Work for Depression?
One of the most promising means of BAR pharmacotherapy is Lamotrigine or Lamictal for bipolar depression.
As known, Lamotrigine for depression and anxiety was originally proposed as a means of antiepileptic therapy. The mechanism of its action is determined by the blockade of potential-dependent slowly inactivating sodium channels of neurons, as a result of which the release into the synaptic gap of excitatory amino acids, primarily glutamate, occurs.
It is important to note that this effect is manifested only in neurons with the presence of epileptogenic activity and is not observed in the normal functioning of neurons, that is, Lamotrigine as antidepressant acts primarily as a corrector of synaptic glutamatergic neurotransmission, a kind of “normalizer” for the activity of glutamatergic neurons.
In addition, Lamotrigine also blocks the potential-dependent calcium channels of the hippocampal neurons, although the physiological role and detailed mechanisms of this phenomenon are not yet fully understood. As a result of this effect, the pathological hyperactivity of the hippocampal neurons in the CA1 region is reduced, a region largely responsible for the regulation of the emotional sphere, cognitive functions and subcortical-cortical relationships.
Subsequent studies have revealed the presence in Lamictal used for depression of a number of other pharmacological effects, to a certain extent capable of explaining the effect of this drug in BAR treatment:
- non-selective inhibition of reuptake of monoamines (including serotonin);
- blockade of monoamine oxidase (MAO) A and B;
- multidirectional effects on glucose metabolism and cerebral blood flow in various regions of the central nervous system (mainly in the paralimbic region, thalamus and cortex);
- increase in the level of GABA in the brain.
Finally, in recent years, these beneficial effects of Lamotrigine on neuroplasticity and receptor reactions in the CNS have also been defined. In general, all of the mentioned above makes it possible to assert that Lamotrigine has a very diverse, polytopic effect on the main links in the bipolar pathogenesis.
Today Lamotrigine is considered not only as the most promising means for pharmacotherapy of bipolar depression and anxiety but also as the only real means for correcting clinical symptoms in this form of pathology without concomitant emotional sphere destabilization. The available results of numerous clinical trials convincingly testify to the prospects and uniqueness of Lamotrigine in drug treatment of depression and anxiety, which allows characterizing this drug as mood stabilizing agent with antidepressant properties.
The evidence base for Lamotrigine effectiveness in the monotherapy of a depression within any type of BAR was obtained in a randomized, double-blind, placebo-controlled trial. They found a dose-dependent effect of Lamotrigine as an antidepressant, which develops fairly quickly (during the first three weeks of admission). The effectiveness of treatment exceeds 50%. The most important advantage of Lamictal in comparison with antidepressants is the absence of affect inversion.
It should also be noted the preventive effect of lamotrigine on the development of an anxiety of any severity. It is especially important to distinguish the positive effect of this drug in bipolar treatment with frequent phase changes, that is, in the clinical form most difficult for pharmacotherapy, when the use of antidepressants, Lithium or Carbamazepine is ineffective.
Effective Lamotrigine Dosage for Bipolar Depression Treatment
Effective Lamotrigine dosage in the bipolar depression treatment, established during clinical trials, is 200-400 mg/day. They should be achieved by titrating the initial dose (25-50 mg/day), depending on the availability of concomitant therapy, for six weeks. When a maintenance stabilizing dose of 200-400 mg/day is reached, it is possible to cancel the additional treatment and switch to monotherapy with Lamotrigine.
Possible Side Effects
Most often the following side effects were observed:
- skin rashes (2-10%);
- headache;
- dizziness;
- discomfort;
- dyspeptic disorders.
The most important advantages of Lamotrigine in the depression and anxiety treatment are its good tolerability and a relatively small number of side effects associated with taking Lamictal.
In most cases, the described reactions did not require the withdrawal of treatment. Nevertheless, it is possible to develop quite severe skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis) both in isolation and within the manifestations of a general hypersensitivity syndrome to the drug. In this case, Lamotrigine should be immediately withdrawn.
Conclusion
It is worth emphasizing that Lamictal (Lamotrigine) combines both high-quality and economic accessibility. This variety of dosage of Lamotrigine provides an opportunity for a rational choice of the strategy and tactics of pharmacotherapy depending on the type of BAR, the polarity of the phase, the severity of the clinical symptomatology, the history, concomitant therapy, etc., which allows maximum treatment individualization. Consequently, all of the above determines the effectiveness of therapy and prognosis, positioning lamotrigine (Lamictal) as the drug of choice in the treatment of BAR in clinical practice.
Watch the video about bipolar disorder for getting more information about this state and its subtypes: