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Maintenance Treatment Outcomes in Older Patients with Bipolar I Disorder

Received August 23, 2004; revised January 13, 2005; accepted January 18, 2005. From Case University School of Medicine and University Hospitals of Cleveland, Cleveland, OH (MS, JRC), the University of Pennsylvania Medical Center and School of Medicine, Philadelphia, PA (LG), and GlaxoSmithKline, Research Triangle Park, NC (TRT, BGW, RW, GE). Send correspondence and reprint requests to Martha Sajatovic, M.D., Department of Psychiatry, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. e-mail: martha.sajatovic{at}uhhs.com
© 2005 American Association for Geriatric Psychiatry

Objective: The efficacy and tolerability of mood stabilizers in older adults with bipolar disorder remains understudied. Authors retrospectively examined response to lamotrigine, lithium, and placebo in older (age 55) adults with Bipolar I disorder (DSM-IV) who participated in two mixed-age, maintenance studies examining time to intervention for an emerging mood episode (manic/hypomanic/mixed or depressed) and drug tolerability. Methods: In all, 588 patients received double-blind lamotrigine (LTG, 100 mg–400 mg/day), lithium (Li, 0.8 mEq/L–1.1 mEq/L), or placebo (PBO); data from 98 older adults (LTG: 33, Li: 34, PBO: 31) were examined. Mean modal total daily doses were LTG 240 mg and Li 750 mg. Results: LTG significantly delayed time to intervention for any mood episode and for a depressive episode, compared with placebo. Li significantly delayed time to intervention for mania/hypomania/mixed compared with placebo. Back pain and headache were the most common adverse events during LTG treatment; rash: LTG, 3%; Li, 6%; and PBO, 0; no serious rash was reported. The most common adverse events (>10%) during lithium treatment were dyspraxia, tremor, xerostomia, headache, infection, amnesia, dizziness, diarrhea, nausea, and fatigue. Conclusion: Lamotrigine and lithium may be effective and well-tolerated maintenance therapies for older adults with Bipolar I depression.

Key Words: Bipolar Disorder • Mood Stabilizers • Lithium • Lamotrigine

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