disorder facial affect recognition with lamotrigine monotherapy in bipolar

Lamotrigine is a broad-spectrum anti-epileptic known to alleviate and prevent depression in bipolar disorder. 1–3 Its therapeutic mechanism remains unclear but at least in healthy controls it may increase brain activity in temporal and ventral prefrontal cortical regions. 4 These regions have also been implicated in the pathophysiology of bipolar disorder. 5–7 They are also part of a distributed neural network involved in sad facial affect information processing 8,9 where abnormal patterns of activation have been observed in patients with depression and bipolar disorder. 10 The aim of the present study was to explore whether lamotrigine monotherapy might redress the functional abnormalities seen in patients with bipolar disorder during sad facial affect recognition. Method Participants Patients Participants were recruited from secondary care services from the South London and Maudsley Hospital. Eligible participants fulfilled the following inclusion criteria: (a) DSM–IV 11 criteria for bipolar disorder, type 1 (b) aged 18–50 years (c) right-handed (d) scoring 514 on the HRSD 12 and 57 on the Young Mania Rating Scale 13 (e) trial of lamotrigine monotherapy was considered appropriate by the patients' treating psychiatrists. Exclusion criteria were: (a) current or past history of alcohol or substance dependence as defined by the DSM–IV; (b) significant comorbid medical or neurological disorder; (c) treatment-resistant bipolar disorder or history of poor medication adherence; (d) history of self-harm or suicide attempts; (e) current suicidal ideation; (f) need of imminent hospitalisation; (g) skin reaction to previous exposure to lamotrigine or other anti-epileptics; (h) in female patients, pregnancy, lactation or inadequate contraception ; (i) current treatment with lithium or depot antipsychotic medication ; (j) history of rapid cycling in the past 3 years; (k) any other comorbid Axis I diagnosis. Patients were screened to confirm their suitability. Diagnosis was established using the Structured Clinical Interview for DSM–IV Axis I Disorders. 14 Consenting patients were withdrawn from their existing medication over a 10-day period. They were then titrated over a 12-week period to a target dose of 200 mg/ day lamotrigine (minimum dose 100 mg/day). During the study only hypnotic medication was allowed as required but not in the 48 h preceding functional magnetic resonance imaging (fMRI) data collection. Throughout the study patients were assessed on a weekly basis. Withdrawal criteria included: (a) their withdrawal of consent (b) deterioration in mental state (c) clinically indicated changes to pharmacotherapy (d) serious adverse event. Controls Patients were individually matched on gender and age …