Strengths:

First product indicated to prevent bipolar depression (EU/International)

• Lamotrigine is the only anti-epileptic drug that is more effective than placebo in the treatment of bipolar depression. Lamotrigine is generally well tolerated and does not cause weight gain. [Danish Guidelines]
• Lamotrigine is more effective against depression than mania in long-term treatment and should be considered for the treatment of patients where depression is the major burden of the illness. [BAP Guidelines]
• The available medicines (for long-term treatment of bipolar disorder) are probably more effective against one pole than the other. Lithium monotherapy is probably effective against both manic and depressive relapse, although it is more effective in preventing mania. Olanzapine prevents manic relapse more than depressive relapse. Lamotrigine prevents depressive relapse more than manic relapse. [BAP Guidelines]
• For bipolar patients with a history of serious depression, lamotrigine may be preferred because of its efficacy for delaying depressive episodes. [ICG Guidelines]
• As early as week 3, lamotrigine-treated patients showed significant improvement of item 1 of the HAM-D score, and the MADRS, CGI-S, and CGI-I scales. [ICG Guidelines]
• At 1 year, almost 60% of patients treated with lamotrigine 200 mg/day were free from intervention for depressive episodes, compared with 45% of patients treated with placebo. [ICG Guidelines]
• Overall, lamotrigine was more effective at delaying intervention for depressive episodes than placebo. [ICG Guidelines]

First product indicated to delay the occurrence of mood episodes (mania, hypomania, depression, and mixed)

• Lamotrigine is the only anti-epileptic drug that is more effective than placebo for the treatment of bipolar depression. Lamotrigine is generally well tolerated and does not cause weight gain. [Danish Guidelines]
• Lamotrigine is more effective against depression than mania in long-term treatment and should be considered for the treatment of patients where depression is the major burden of the illness. [BAP Guidelines]
• The available medicines (for long-term treatment of bipolar disorder) are probably more effective against one pole than the other. Lithium monotherapy is probably effective against both manic and depressive relapse, although it is more effective in preventing mania. Olanzapine prevents manic relapse more than depressive relapse. Lamotrigine prevents depressive relapse more than manic relapse. [BAP Guidelines]

Lamotrigine for acute depression

• Results of a double-blinded, placebo-controlled trial demonstrated that lamotrigine was efficacious for the treatment of acute bipolar I depression. [ICG Guidelines]
• The first-line pharmacological treatment for bipolar depression is initiation of lamotrigine or lithium. [APA Guidelines]

Excellent clinical trial and regulatory experience

• Evidence demonstrating the efficacy and safety of lamotrigine use for 18 months is available.  [ICG Guidelines]