Psychiatry and Clinical Neurosciences, December 2018, Vol.72(12), pp.864-875
Byline: Ilaria Cuomo, Daria Piacentino,Georgios D. Kotzalidis, Luana Lionetto, Sergio De Filippis Keywords: bipolar disorder; depression; global functioning; lacosamide; mania Aim Bipolar disorder (BD) is often treated with anticonvulsants. Lacosamide has not been tested in BD. We assessed its effects in a hospital setting in patients with BD without epilepsy. Methods We treated 102 consecutive hospitalized patients with acute BD with lacosamide 50-300 mg/day. We compared this sample with a retrospective sample treated with other antiepileptics (OAE). We rated patients after 3, 7, 15, and 30 days of treatment with the Brief Psychiatric Rating Scale, Young Mania Rating Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Clinical Global Impressions - Severity, and Global Assessment of Functioning. Results Patients receiving lacosamide were significantly younger and had fewer mixed episodes at intake, and less substance use disorder comorbidity than those receiving OAE. Both groups showed positive effects on all measures. The two groups did not differ on any clinical measure at baseline, but from the 3rd day on, lacosamide patients fared better than OAE patients on the Young Mania Rating Scale and Clinical Global Impressions - Severity and worse on the Hamilton Anxiety Rating Scale. From the 15th day, OAE patients scored better on the Brief Psychiatric Rating Scale. Global Assessment of Functioning scores were significantly more improved in the lacosamide patients. Age, substance use disorder comorbidity, episode type, and educational level significantly affected results. No interactions were found amongst these parameters. Conclusion Lacosamide was effective in reducing psychopathology, mania, depression, and anxiety and in improving global functioning in patients with BD-I/II disorder in the short term, with few side-effects. Lacosamide improved mania, clinical severity, and global functioning better than OAE at doses lower than those used in epilepsy. CAPTION(S): Table S1. Intragroup comparisons of effects of treatments vs baseline at the different time-points considered (cut-off P 〈 0.007). Table S2. Effect sizes of treatments on all considered measures for all groups. Table S3. Intragroup comparisons for substance use disorders (SUD) comorbid vs SUD non-comorbid subsamples (cut-off P 〈 0.007, save for age, P 〈 0.05).
Bipolar Disorder ; Depression ; Global Functioning ; Lacosamide ; Mania