In mehreren Studien wurden Veränderungen des Medikamentenmetabolismus von Psychopharmaka durch entzündliche Prozesse beschrieben. Diese Effekte können zu Therapieversagen oder sogar gravierenderen unerwünschten Arzneimittelwirkungen führen. Aus diesem Grund haben wir untersucht, ob im Laufe inflammatorischer Prozesse eine Veränderung der Medikamentenserumkonzentration der Stimmungsstabilisatoren Valproat (VPA), Lamotrigin (LTG) oder Carbamazepin (CBZ) auftritt. / Alterations in drug metabolism due to inflammation are reported for several psychotropic drugs. These effects may lead to treatment failure or even severe side effects. Therefore, we investigated whether there are alterations in drug serum concentration of the mood stabilizers valproate (VPA), lamotrigine (LTG) and carbamazepine (CBZ) during inflammatory activity.

Bipolar disorder is a severe, affective illness which causes a person to alternate between episodes of pathologically elevated mood (mania) and depression – in between these episodes the mood is normal. The length and intervals between the episodes are highly variable among the ill, as are the severity which is divided into two major subgroups: bipolar I and II. Bipolar I disorder is the most severe because of the patient’s inability to realize that he or she is currently in a manic phase, in the case of bipolar II disorder, the patient is aware that he or she has an abnormally raised mood, a state which is called hypomanic state instead of manic. The cause of bipolar disorder is yet to be discovered, although both genetic and environmental aspects probably weigh in. Bipolar disorder is treated with a combination of psychotherapy and pharmacology, the most common and oldest treatment regimen being that of lithium, an alkali metal which has been used as a mood stabilizer for over a century. Although being proven effective, lithium can cause thyroid malfunction and has a complicated renal elimination process that can be affected by diet and heritage. This makes regular blood testing for determining concentration of lithium necessary. Lithium can also be toxic in relatively low doses. Lamotrigine is an anticonvulsive drug used for treating epilepsy, but has been proven to also have mood stabilizing properties. To find out if lamotrigine can be used as a treatment for bipolar disorder, both as maintenance treatment as well as acute treatment in manic/hypomanic/depressive episodes, papers from clinical trials where lamotrigine has been tested with lithium and/or placebo have been read. The results show that lamotrigine is as effective as lithium in maintenance and acute treatment of depression, although some papers show conflicting results on the effectiveness compared to placebo. The conclusion is that lamotrigine seems to be a promising drug that can be helpful in the treatment of bipolar disorder.

Bakgrund: Bipolär sjukdom är ett kroniskt psykiskt sjukdomstillstånd som brukar delas upp i typ 1 och typ 2. Prevalensen för bipolär sjukdom typ 1 är knappt 1 % och för typ 2 cirka 2-4 %. Det är inte känt vad som orsakar sjukdomen men det förekommer en hög ärftlighet där det genetiska bidraget uppskattas till 56,4 – 61,8 %. Sjukdomen har ett periodiskt förlopp där patienten drabbas av depressiva, maniska eller hypomaniska episoder växlat med symtomfria perioder där patienten mår bra och kan leva i stort sätt som vanligt. Sjukdomsförloppet kan variera kraftigt och vissa patienter kan vara helt symtomfria under decennier medan vissa kan ha en kronisk funktionsnedsättning på grund av sjukdomen. Det finns inget botemedel till sjukdomen och för att undvika nya episoder och hålla stämningsläget stabilt används förebyggande läkemedelsbehandling livet ut. Som profylaktisk behandling rekommenderas bland annat stämningsstabiliserande läkemedel som litium och antiepileptikum som lamotrigin. Beroende på patientens symtombild kan läkemedel antingen användas som monoterapi eller i kombination med andra läkemedel. Syfte: Syftet med denna litteraturstudie var att jämföra läkemedlen lamotrigin och litium, både vid profylaktisk behandling och vid behandling av akut mani eller depression, hos patienter med bipolär sjukdom. Metod: Artiklarna som granskades i denna litteraturstudie hittades via sökmotorn PubMed. Det var fem kliniska studier och en registerbaserad kohortstudie som valdes ut. I artiklarna jämfördes lamotrigin och litium både vid profylaktisk behandling och vid akut behandling hos patienter med bipolär sjukdom. Resultat: Fyra av de fem kliniska studierna fann inga signifikanta skillnader mellan lamotrigin och litium vid behandling av bipolär sjukdom. En klinisk studie fann att lamotrigin hade bättre effekt vid behandling av patienter med ”rapid cycling” bipolär sjukdom. Den registerbaserade kohortstudien fann att litium var överlägsen lamotrigin vid behandling av patienter med diagnosen bipolär sjukdom. Slutsats: Lamotrigin kan vara lika effektivt som litium men det går inte att säga att lamotrigin är ett bättre alternativ än litium vid behandling av bipolär sjukdom. Båda läkemedlen har relativt likvärdig effektivitet och båda har biverkningar som kan vara ganska besvärliga. / Background: Bipolar disorder is a chronic mental illness that is categorized into type 1 and type 2. The prevalence of bipolar disorder type 1 is about 1 % and that of type 2 about 2-4 %. The cause of the illness is unknown but the genetic contribution is estimated to be between 56,4 – 61,8 %. It is a periodical illness and the patient experiences depressive, manic or hypomanic episodes as well as periods with no symptoms at all. During the symptom-free periods the patient feels good and can live life with relative normalcy. The way the illness progresses can vary greatly. Some patients can be completely symptom free for decades whereas some patients can have a chronic disability because of the illness. There is no cure available for the disease. To avoid new episodes and keep their mood stable, patients require pharmacological maintenance treatment for the rest of their life. The mood stabilizing drug lithium and the antiepileptic drug lamotrigine are recommended as maintenance treatment. Depending on the symptoms the drugs can be used in monotherapy or in combination with other drugs. Psychotherapy can complement the pharmacological treatment. The main goal with therapy is to educate the patients and their family members and give them strategies for coping with stress, and to recognize and treat early signs of an oncoming episode. It is also important for the patient to have a lifestyle where regular meals during the day, proper sleep and exercise is prioritized. Therapy can also play an important role in making the patient understand the importance of taking the prescribed medication according to the doctor’s recommendations. Objective: The purpose of this study was to compare the drugs lamotrigine and lithium, both as maintenance treatment and as treatment for acute manic or depressive episodes, in patients with bipolar disorder. Method: The articles that were analyzed in this literature study were located by the use of the database PubMed. Five of the articles described clinical studies and one described a register based cohort-study. The articles compared lamotrigine and lithium as maintenance treatment and as treatment during an acute episode in patients with bipolar disorder. Results: In four of the five clinical studies no significant differences between lamotrigine and lithium in the treatment of bipolar disorder were identified. In a single clinical study it was found that lamotrigine had better effect during treatment of patients with rapid cycling bipolar disorder. The register based cohort-study found that lithium was superior to lamotrigine in the treatment of patients with the diagnosis bipolar disorder. Conclusions: Lamotrigine can be as effective as lithium but it cannot be concluded that lamotrigine is a better choice than lithium in the treatment of bipolar disorder. Both drugs have a similar effectiveness and both have side effects that can be difficult for patients to live with.