Effect of open-label lamotrigine as monotherapy and adjunctive therapy on the self-assessed cognitive function scores of patients with bipolar I disorder.

Cognitive deficits in patients with bipolar disorder are likely to impair occupational and social functioning. In a post hoc analysis of data from a prospective, open-label study of lamotrigine in 1175 patients 13 years or older with bipolar I disorder, changes in the self-rated cognitive function scores of patients receiving lamotrigine as monotherapy or as adjunctive therapy were evaluated. Lamotrigine was given for 12 weeks, with a target dosage of 200 mg/d. Cognitive function was assessed at baseline and week 12 with the self-rated Medical Outcomes Study Cognitive (MOS-Cog) Scale. Mean MOS-Cog scores improved significantly from baseline in the overall group (+8.4 +/- 22.55 points, P < 0.0001) and in subgroups of patients receiving and not receiving concomitant valproate, antidepressants, or antipsychotics. Patients receiving lamotrigine and not receiving concomitant antipsychotics, however, exhibited a small but significantly greater degree of improvement than patients who were receiving concomitant antipsychotics (adjusted mean difference = 4.05; 95% confidence interval, 1.30-6.81; P = 0.0039). Statistically significant improvement was seen in patient subgroups with a depressive (mean change from baseline, 8.8 +/- 21.97; P < 0.0001) or a manic (mean change from baseline, 7.5 +/- 22.62; P = 0.0007) index episode. Improvements in MOS-Cog scores significantly correlated with improvement in both depressive (correlation coefficient, -0.339; P < 0.0001) and manic (correlation coefficient, -0.151; P < 0.0001) symptoms. Overall, self-rated cognitive function scores improved during open-label lamotrigine therapy in patients with bipolar I disorder whether or not they were receiving concomitant valproate, antidepressants, or antipsychotics. Additional research is needed to explore the clinical relevance of these findings.

Is your depressed patient bipolar?

Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essential, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treatment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdiagnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive features and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifically on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physician can easily perform this assessment. Tools to assist the physician in daily practice with the evaluation and recognition of bipolar disorders and bipolar depression are presented and discussed.