Tranylcypromine vs. lamotrigine in the treatment of refractory bipolar depression: a failed but clinically useful study

W. A. Nolen*, R. W. Kupka, G. Hellemann, M. A. Frye, L. L. Altshuler, G. S. Leverich, T. Suppes, P. E. Keck, S. McElroy, H. Grunze, J. Mintz, R. M. Post

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: To compare the efficacy and tolerability of tranylcypromine vs. lamotrigine in bipolar depression not responding to conventional antidepressants.

Method: Bipolar depressed patients received open randomized treatment with tranylcypromine or lamotrigine as add-on to a mood stabilizer during 10 weeks. In a second treatment phase, non-responding patients could receive the opposite drug. Outcome criteria were response (measured with CGI-BP and IDS-C), switch into mania, and completion of the study.

Results: Only 20 of 70 planned patients were randomized, due to problems with recruitment, and 19 patients received any medication. During the first treatment phase 5/8 patients (62.5%) responded to tranylcypromine without switch into mania, compared with 4/11 patients (36.4%) on lamotrigine with two switches (statistically not significant). Over both treatment phases, 8/10 patients (80%) receiving tranylcypromine completed the study vs. 5/13 (38.5%) on lamotrigine (likelihood 0.02).

Conclusions: There still appears to be a role for tranylcypromine in the treatment of refractory bipolar depression. Larger controlled studies are demanded.

Original languageEnglish
Pages (from-to)360-365
Number of pages6
JournalActa Psychiatrica Scandinavica
Volume115
Issue number5
DOIs
Publication statusPublished - May-2007

Keywords

  • bipolar disorder
  • bipolar depression
  • tranylcypromine
  • lamotrigine
  • lithium
  • anticonvulsant
  • MOOD STABILIZERS
  • MAINTENANCE TREATMENT
  • VENLAFAXINE
  • DISORDER
  • MANIA
  • ANTIDEPRESSANTS
  • IMIPRAMINE
  • SERTRALINE
  • BUPROPION
  • CROSSOVER

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