Clinical factors leading to lamotrigine prescription in bipolar outpatients: Subanalysis of the SIN-DEPRES study

Abstract: Background: The use of lamotrigine is a point of discrepancy among the diverse guidelines published on the management of bipolar disorder (BD). Evidence supporting the long-term efficacy is reasonably robust. Nonetheless, the effectiveness of lamotrigine in acute treatment is vigorously debated and it is unclear how this drug is used in routine clinical practice. This subanalysis of the SIN-DEPRES study was designed to understand the clinical profile of bipolar patients receiving lamotrigine. Methods: In this prospective national multicenter study, 652 patients with clinically stable bipolar I and II disorder were recruited. Clinical assessments included sociodemographic and clinical data, the Modified Clinical Global Impression scale for BD (CGI-BP-M), the Hamilton Depression Rating Scale (HDRS), and prescriptions of psychotropic medications and their doses. Results: By means of a logistic regression model, an association between receiving treatment with lamotrigine and the following clinical variables was found: number of past depressive episodes (O.R.=2.875, 95% CI: 1.203–6.869, p=0.018), depressive polarity of the most recent episode (O.R.=1.945, 95% CI: 1.267–2.985, p=0.002), severity in CGI-BD-M depression (O.R.=1.850, 95% CI: 1.215−2.817, p=0.004), bipolar II disorder diagnosis (O.R.=1.635, 95% CI: 1.078–2.482, p=0.021) and number of episodes per year (O.R.=1.310, 95% CI: 1.069–1.605, p=0.009). Limitations: Subanalysis of the SIN-DEPRES study with a cross-sectional design. Conclusions: The use of lamotrigine in clinical practice is in accordance with most of the guidelines, which support its use in patients with depressive predominant polarity and bipolar II disorder. [Copyright &y& Elsevier]