Effectiveness of quetiapine plus lamotrigine maintenance therapy in challenging bipolar disorder patients

Objective quetiapine plus lamotrigine (QTP + LTG) combination maintenance therapy effectiveness in challenging bipolar disorder (BD). ients assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Affective Disorders Evaluation and followed with the STEP-BD Clinical Monitoring Form were naturalistically prescribed QTP + LTG. s 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 episodes, 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. tions cebo comparison group. Small sample of predominantly female Caucasian insured outpatients taking complex concurrent medication regimens. sion onal studies are warranted to confirm our preliminary observation that QTP + LTG maintenance may be effective in patients with challenging BD.