Randomized, double-blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression

Background: Uncertainty exists regarding the best approach for treating bipolar depression among patients already receiving a first-line mood stabilizer. The aim of this pilot study was to compare adding a second mood stabilizer or an antidepressant at this treatment decision point. Methods: Twelve-week, randomized, double-blind pilot trial comparing the addition of lamotrigine or citalopram for bipolar depressed patients on mood stabilizer medication. Change in depressive symptoms and risk of switch were examined. Results: Twenty subjects were randomized. Each treatment group experienced a significant mean reduction in total MADRS scores (citalopram Delta - 14.2, p = 0.002; lamotrigine Delta - 13.3, p = 0.00 1), and there was no significant difference between treatment groups (p=0.78). Total response rates increased from 31.6% at week 6 to 52.6% at week 12. One out of ten patients in each group experienced a switch to hypomania. Limitations: Small sample size. Lack of a placebo arm. Conclusions: Results of this small trial suggest that both larnotrigine and citalopram appear to be reasonable choices as add-on acute treatment for bipolar depression, with response rates continuing to rise considerably past 6 weeks of treatment. (c) 2006 Elsevier B.V. All rights reserved.