Preliminary communication Effectiveness of quetiapine plus lamotrigine maintenance therapy in challenging bipolar disorder patients Pichai Ittasakul a , Kaja R. Johnson b , Shefali Srivastava b , Meredith E. Childers b , John O. Brooks III c , Jennifer C. Hoblyn b, d , Terence A. Ketter b, ⁎ a Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand b Stanford University School of Medicine, Stanford, CA, United States c UCLA Semel Institute, Los Angeles, CA, United States d Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, United States article info abstract Article history: Received 1 November 2011 Received in revised form 15 November 2011 Accepted 1 December 2011 Available online 10 January 2012 Objective: Assess quetiapine plus lamotrigine (QTP + LTG) combination maintenance therapy effectiveness in challenging bipolar disorder (BD). Method: Outpatients assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Affective Disorders Evaluation and followed with the STEP-BD Clinical Moni- toring Form were naturalistically prescribed QTP + LTG. Results: Fifty-four outpatients with challenging BD, taking in addition to QTP+LTG, a mean±SD of 2.1±1.6 (in 63.0% at least 2) other psychotropic and 2.3±1.9 non-psychotropic prescription medications, had QTP+LTG maintenance trials. Median(mean±SD) QTP+LTG duration was 401(730±756) days. Final QTP and LTG doses were 87.5(188 ±211) and 300(287±108) mg/ day, respectively. Half (27/54) of patients discontinued QTP (in 19), LTG (in 6), or QTP+LTG (in 2), after 294(415±414) days — due to side-effects in 10, inefficacy in seven, non-adherence in five, and other reasons in five. 42.6%(23/54) had additional pharmacotherapy intervention for emergent mood symptoms, after 175(261±237) days, with at least one psychotropic added (in 16/54) or substantively (by ≥50%) increased (in 7/54). 55.6%(30/54) had recurrent mood ep- isodes, after 126(187 ± 158) days, most often depressive (in 35.2%), although 64.8%(35/54) were euthymic at final visit taking QTP + LTG. Sedation increased significantly during treatment among those with side-effect discontinuations, and 19.2%(10/52, all having QTP added to LTG) had clinically significant (≥7%) weight gain. Limitations: No placebo comparison group. Small sample of predominantly female Caucasian insured outpatients taking complex concurrent medication regimens. Conclusion: Additional studies are warranted to confirm our preliminary observation that QTP + LTG maintenance may be effective in patients with challenging BD. © 2011 Elsevier B.V. All rights reserved. Keywords: Bipolar disorder Lamotrigine Quetiapine Long-term Effectiveness 1. Introduction Bipolar disorder, is a common, serious, recurrent psychiatric illness marked by episodes of depression and mood elevation that entails serious psychosocial consequences and high mortality rates (Ketter, 2010), although its progression may be attenuated by preventing episodes (Post, 1992; Roy-Byrne et al., 1985). The second-generation antipsychotic quetiapine has prominent efficacy advantages, being the only currently available agent with United States Food and Drug Adminis- tration (US-FDA) approval for all three phases of bipolar dis- order (acute mania, acute bipolar depression and bipolar maintenance) (Ketter, 2010). In contrast, the mood stabilizer Journal of Affective Disorders 137 (2012) 139–145 ⁎ Corresponding author at: 401 Quarry Road, Room 2124, Stanford, CA 94305-5723, United States. Tel.: +1 650 723 2515; fax: +1 650 723 2507. E-mail address: tketter@stanford.edu (T.A. Ketter). 0165-0327/$ – see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2011.12.024 Contents lists available at SciVerse ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad