Adjunctive Lamotrigine Treatment for Major Depression

Ms. A was a 45-year-old woman who had been diagnosed with recurrent major depressive disorder; her therapeutic trials of bupropion, phenelzine, venlafaxine, imipramine, and nortriptyline had failed, and she had only been partially responsive to ECT. To her regimen of tranylcypromine, 70 mg/day, lithium carbonate, 1200 mg/day, and clonazepam (0.5 mg/day b.i.d. as needed, used sparingly for anxiety) treatment was added lamotrigine, 25 mg/day, and titrated to 75 mg/day within 3 weeks. Within 8 weeks, Ms. A reported a dramatic improvement in her mood and shortly thereafter returned to work. She continued to do well on this treatment regimen when assessed 6 months later.

Ms. B was a 43-year-old woman with recurrent major depressive disorder whose therapeutic trials of venlafaxine, fluoxetine, and paroxetine had failed. In addition, she could not tolerate a trial of nefazodone treatment. To her regimen of fluoxetine, 50 mg/day, and bupropion, 150 mg/day (sustained-release preparation), was added lamotrigine, 25 mg/day. Within 4 weeks, she, too, reported a dramatic improvement. “I can’t remember the last time I felt this good,” she commented. She continued to do well when assessed 2 months later.