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

BackgroundUncertainty 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.MethodsTwelve-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.ResultsTwenty subjects were randomized. Each treatment group experienced a significant mean reduction in total MADRS scores (citalopram Δ — 14.2, p = 0.002; lamotrigine Δ — 13.3, p =  0.001), 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.LimitationsSmall sample size. Lack of a placebo arm.ConclusionsResults of this small trial suggest that both lamotrigine 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.