Does lamotrigine cause weight loss. Lamotrigine and Weight Loss in Bipolar I Disorder: Effectiveness and Side Effects

07.11.202113.07.2023 by alexxlab

Does lamotrigine cause weight loss in patients with bipolar I disorder. How does lamotrigine compare to lithium and placebo in terms of weight effects. What are the clinical implications of lamotrigine’s weight profile for bipolar disorder treatment.

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Understanding Lamotrigine’s Role in Bipolar I Disorder Treatment

Lamotrigine is an anticonvulsant medication that has gained significant attention in the treatment of bipolar I disorder. Its effectiveness as a maintenance therapy has been well-established, but questions remain about its impact on body weight. This article delves into the research examining lamotrigine’s weight effects in comparison to placebo and lithium, another common mood stabilizer.

The Study: Comparing Lamotrigine, Lithium, and Placebo

A comprehensive study analyzed data from two double-blind, placebo- and lithium-controlled trials that lasted 18 months. The study included a total of 583 patients with bipolar I disorder, divided into three groups:

Lamotrigine group: 227 patients
Placebo group: 190 patients
Lithium group: 166 patients

The researchers aimed to assess the effect of lamotrigine maintenance therapy on body weight compared to placebo and lithium.

Key Findings: Weight Changes Over Time

The study revealed interesting patterns in weight changes across the three treatment groups:

Mean Weight Changes at 52 Weeks

Lamotrigine: -1.2 kg
Placebo: +0.2 kg
Lithium: +2.2 kg

These findings suggest that lamotrigine was associated with a slight weight loss, while lithium led to weight gain. However, it’s important to note that the differences between lamotrigine and placebo were not statistically significant.

Clinically Significant Weight Changes

The study also examined the percentage of patients experiencing clinically significant weight changes, defined as a 7% or greater increase or decrease in body weight:

Weight gain ≥7%:
- Lamotrigine: 10.9%
- Placebo: 7.6%
- Lithium: 11.8%
Weight loss ≥7%:
- Lamotrigine: 12.1%
- Placebo: 11.5%
- Lithium: 5.1%

These results indicate that lamotrigine was comparable to placebo in terms of both weight gain and weight loss. Interestingly, the percentage of patients experiencing significant weight loss was higher with lamotrigine compared to lithium.

Lamotrigine’s Weight Profile: Stability and Neutrality

One of the most striking findings of this study is the overall weight stability associated with lamotrigine treatment. Unlike many other psychotropic medications, which often lead to significant weight gain, lamotrigine appears to have a neutral effect on body weight.

Why is weight stability important in bipolar disorder treatment? Weight gain is a common side effect of many mood stabilizers and antipsychotics used to treat bipolar disorder. This can lead to:

Increased risk of metabolic syndrome
Cardiovascular complications
Reduced treatment adherence
Negative impact on self-esteem and quality of life

Lamotrigine’s weight-neutral profile may offer an advantage for patients who are particularly concerned about weight gain or who have a history of weight-related health issues.

Comparing Lamotrigine to Lithium: Weight Effects and Implications

The study provides valuable insights into the weight effects of lamotrigine compared to lithium, a well-established mood stabilizer:

Lithium and Weight Gain

Lithium was associated with an average weight gain of 2.2 kg over 52 weeks. This finding is consistent with previous research, although the magnitude of weight gain was lower than in some earlier studies. Possible explanations for this include:

Improved awareness of weight gain as a side effect, leading to better management
Lower dosages of lithium used in contemporary practice
Differences in study populations or design

Lamotrigine’s Advantage

The study found a statistically significant difference in weight changes between lamotrigine and lithium, with lamotrigine showing a tendency towards slight weight loss. This difference of 3.4 kg between the two treatments could be clinically meaningful for some patients.

Is lamotrigine a better choice than lithium for all patients with bipolar disorder? While weight effects are important, they are just one factor to consider in treatment selection. Other factors include:

Individual response to medication
Overall efficacy in mood stabilization
Other side effects and tolerability
Patient preferences and treatment history

The choice between lamotrigine and lithium should be made on a case-by-case basis in consultation with a healthcare provider.

Clinical Implications of Lamotrigine’s Weight Profile

The weight-neutral profile of lamotrigine has several important implications for clinical practice:

1. Treatment Selection

Lamotrigine may be a preferred option for:

Patients with a history of medication-induced weight gain
Individuals with obesity or metabolic disorders
Those particularly concerned about weight-related side effects

2. Long-term Adherence

The absence of significant weight gain may improve long-term adherence to treatment, which is crucial for maintaining mood stability in bipolar disorder.

3. Metabolic Health

By avoiding weight gain, lamotrigine may help reduce the risk of metabolic syndrome and associated health complications in patients with bipolar disorder.

4. Combination Therapy

Lamotrigine’s weight-neutral profile may make it a valuable option in combination with other medications that have a higher likelihood of causing weight gain.

Limitations and Future Directions

While this study provides valuable insights into lamotrigine’s weight effects, it’s important to consider its limitations:

Retrospective analysis: The study was based on data from previous trials, which may limit the ability to control for all relevant factors.
Duration: The analysis was truncated at 52 weeks due to high rates of missing data beyond this point. Longer-term studies may be needed to fully understand the weight effects of lamotrigine.
Population specificity: The study focused on patients with bipolar I disorder. Further research is needed to confirm these findings in other psychiatric populations.

Future research directions could include:

Prospective studies specifically designed to assess weight changes
Investigation of lamotrigine’s effects on metabolic parameters beyond weight
Exploration of potential mechanisms underlying lamotrigine’s weight-neutral profile
Studies comparing lamotrigine to other mood stabilizers and antipsychotics in terms of weight effects

Practical Considerations for Patients and Clinicians

For patients considering lamotrigine as a treatment option, and for clinicians prescribing it, several practical points are worth noting:

Monitoring Weight and Metabolic Parameters

While lamotrigine appears to be weight-neutral, individual responses can vary. Regular monitoring of weight and metabolic parameters is still recommended for all patients on psychiatric medications.

Dosage Considerations

The study did not specifically examine the relationship between lamotrigine dosage and weight effects. Clinicians should follow established guidelines for dosing and titration, while being attentive to any weight changes that may occur.

Combination Therapy

When lamotrigine is used in combination with other medications, the overall weight effect may differ. Careful monitoring and adjustment of treatment regimens may be necessary.

Patient Education

Patients should be informed about the potential weight effects of different medication options. This can help in shared decision-making and may improve treatment adherence.

Lifestyle Factors

While medication choice is important, lifestyle factors such as diet and exercise also play a crucial role in weight management for patients with bipolar disorder. Encouraging healthy lifestyle habits should be an integral part of treatment.

Can lamotrigine be used as a weight loss medication for patients without bipolar disorder? Lamotrigine is not approved or recommended for weight loss in individuals without a psychiatric indication. Its use should be limited to approved indications under medical supervision.

Conclusion: Lamotrigine’s Place in Bipolar Disorder Treatment

The study discussed in this article provides compelling evidence for lamotrigine’s weight-neutral profile in the treatment of bipolar I disorder. Key takeaways include:

Lamotrigine was associated with stable body weight over 52 weeks of treatment
It showed no significant difference from placebo in terms of weight changes
Compared to lithium, lamotrigine was associated with a relative weight advantage
The incidence of clinically significant weight changes was similar between lamotrigine and placebo

These findings support the use of lamotrigine as a valuable option in the treatment of bipolar disorder, particularly for patients who are concerned about weight gain or who have a history of medication-induced weight issues. However, it’s important to remember that treatment decisions should be individualized, taking into account a range of factors beyond weight effects.

As research in this area continues to evolve, lamotrigine’s role in bipolar disorder treatment may be further refined. For now, its weight-neutral profile offers an important alternative in the armamentarium of mood stabilizers, potentially improving long-term treatment outcomes and quality of life for many patients with bipolar disorder.

Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder

Randomized Controlled Trial

. 2006 Apr;8(2):175-81.

doi: 10.1111/j.1399-5618.2006.00308.x.

Gary Sachs¹, Charles Bowden, Joseph R Calabrese, Terence Ketter, Thomas Thompson, Robin White, Beth Bentley

Affiliations

Affiliation

¹ Department of Psychiatry, Harvard University, Harvard Bipolar Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. [email protected]

PMID:
16542188
DOI:
10.1111/j.1399-5618.2006.00308.x

Randomized Controlled Trial

Gary Sachs et al.

Bipolar Disord.

2006 Apr.

. 2006 Apr;8(2):175-81.

doi: 10.1111/j.1399-5618.2006.00308.x.

Authors

Gary Sachs¹, Charles Bowden, Joseph R Calabrese, Terence Ketter, Thomas Thompson, Robin White, Beth Bentley

Affiliation

¹ Department of Psychiatry, Harvard University, Harvard Bipolar Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. [email protected]

PMID:
16542188
DOI:
10.1111/j.1399-5618.2006.00308.x

Abstract

Objective:

The effect of lamotrigine maintenance therapy on body weight was assessed retrospectively in analyses of data from two double-blind, placebo- and lithium-controlled, 18-month studies in patients with bipolar I disorder (n = 227 for lamotrigine, 190 for placebo, 166 for lithium).

Methods:

Endpoints included mean change in weight, the percentage of patients with > or = 7% change (increase, decrease, fluctuation) in weight, and the percentage of patients with weight-related adverse events during double-blind treatment.

Results:

Mean weight remained stable during maintenance therapy with lamotrigine. In a mixed-model repeated-measures analysis, mean changes in weight (kg) at week 52 were -1.2 with lamotrigine, +0.2 with placebo, and +2.2 with lithium [estimated difference (95% CI) lamotrigine minus placebo = -1.3 (-3.6, 0.9), p = 0.237; lithium minus placebo = +2.0 (-0.3, 4.4), p = 0.094; lithium minus lamotrigine = +3.4 (1.4, 5.4), p < 0.001]. Analyses were truncated at week 52 because of the high incidence of missing data at later time points. The percentages of patients with a >/=7% weight gain, during randomized treatment, were 10. 9%, 7.6% and 11.8% for the lamotrigine, placebo, and lithium groups, respectively. The percentages of patients with a > or = 7% weight loss, during randomized treatment, were 12.1%, 11.5%, and 5.1% for the lamotrigine, placebo, and lithium groups, respectively. The percentage of patients with a > or = 7% weight loss did not significantly differ between lamotrigine and placebo but was significantly higher with lamotrigine than lithium. The incidences of > or = 7% weight changes and of weight changes reported as adverse events were comparable between active treatments and placebo.

Conclusion:

Lamotrigine was associated with stable body weight during 1 year of treatment and was comparable to placebo in mean weight change, incidence of clinically significant weight change, and incidence of weight changes reported as adverse events in patients with bipolar disorder. Lithium was associated with weight gain, but the magnitude of lithium-associated weight gain was lower in the current analysis than in previous studies.

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Publication types

MeSH terms

Substances

Bipolar Medications and Weight Loss

Introduction

Bipolar disorder can be treated with medications from different drug groups. These groups include mood stabilizers, antipsychotics, and antidepressants. The drugs in each of these groups affect your body differently, including how they affect your weight. Here’s a look at how some of the more common drugs for bipolar disorder affect your weight, plus their other side effects.

Most bipolar drugs cause weight gain rather than weight loss. For example, several of them increase your blood sugar level, which can lead to weight gain. Others affect your energy level. During manic episodes, you typically may not sleep much and may burn off lots of energy. Taking a bipolar drug can calm your mood and help you sleep. In turn, these effects could decrease the amount of energy your body burns. This can lead to an increase in weight, especially if you don’t adjust your diet. However, the way that these drugs can affect your weight varies.

Mood stabilizers

Low risk of weight gain: Lamotrigine (Lamictal) is most likely to cause weight loss. However, it can also cause weight gain. Other common side effects of this drug include:

headache
trouble sleeping
drowsiness
upset stomach
aches and pains throughout your body

Risk of weight gain: Valproate is likely to cause weight gain. It may also cause tremors, headaches, dizziness, and nausea.

High risk of weight gain: Lithium is known for causing weight gain. Common side effects of this drug also include:

sleepiness
fatigue
low blood pressure
slowed thyroid function
mild nausea

Antipsychotics

Low risk of weight gain: Lurasidone has a low risk of weight gain. Other side effects of this drug may include the development of breasts in men, low blood pressure, and fainting.

Risk of weight gain: Quetiapine can cause weight gain. Common side effects may also include:

changes in blood pressure
nausea
cataracts
development of breasts in men
reduced thyroid function

High risk of weight gain: Olanzapine is very likely to causeweight gain because it increases your appetite. Other common side effects can include:

dry mouth
thirst
frequent urination
constipation
dizziness
sleepiness
weakness
movement disorders and tremor

There are several different drugs available to treat bipolar disorder. Most of them affect your weight, but many increase your risk of weight gain rather than weight loss. By making healthy choices in your diet and adding routine exercise, you may be able to minimize these effects.

Many people with bipolar disorder often have to try several different drugs before finding one that works. Talk to your doctor and balance your concerns about weight gain with the likelihood of a certain drug working well for you. Tell your doctor about your health history, your family’s health history, and your concerns about how treatment will affect your weight. This information will help your doctor understand which drugs are more likely to work well for you.

Lamotrigine

Lamotrigine is an anticonvulsant drug used to treat various forms of epilepsy and mood disorders in bipolar disorder.

Synonyms Russian

Lamictal, lameptil, convulsan, lamitor, lamolep, lamotriks, seizar, triginet.

English synonyms

Lamotrigin, Lamictal.

Test Method

Gas Chromatography-Mass Spectrometry (GC-MS).

Units

μg/mL (micrograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

Do not eat for 2-3 hours before the examination, you can drink pure non-carbonated water.
Children under 1 year of age should not eat for 30-40 minutes prior to testing.
Do not smoke for 30 minutes before the test.

Overview of the study

Lamotrigine is a broad-spectrum antiepileptic drug for various forms of epilepsy that may have beneficial effects on mood in bipolar disorders. The drug is used as mono- or additional therapy for partial and generalized convulsive seizures, seizures with Lennox-Gastaut syndrome, with typical absences, as well as for the prevention of mood disorders (depression, mania, hypomania) in patients with bipolar disorder. In addition, lamotrigine is being considered for migraine, trigeminal neuralgia, and treatment-refractory depression.

Its pharmacological action is associated with the blocking of voltage-gated sodium channels, stabilization of the nerve cell membrane and suppression of the release of glutamic acid.

The bioavailability of lamotrigine is very high at 98%. After oral administration, the drug is quickly and fairly completely absorbed from the gastrointestinal tract, food intake slows down the absorption process, but does not reduce its effectiveness. The maximum concentration in the blood is observed 2.5 hours after ingestion. Binding to blood proteins is not more than 55%. Therapeutic concentration in the blood is 2. 5-15 mcg / ml. Lamotrigine is metabolized in the liver by conjugation with glucuronic acid using the enzyme glucuronyl transferase and without the participation of the cytochrome P450 system. The elimination half-life of lamotrigine is 24-35 hours and depends on the co-administered medicinal products. The drug is excreted from the body mainly by the kidneys in the form of glucuronides or unchanged (10%), and about 2% – through the intestines.

While taking lamotrigine, headache, fatigue, drowsiness or insomnia, nausea, vomiting, a decrease in the number of leukocytes and platelets in the blood, skin rashes and allergic reactions may occur, in rare cases, Stevens-Johnson syndrome, Lyell’s syndrome may develop. In some cases, abrupt discontinuation of the drug can provoke epileptic seizures, so when you cancel lamotrigine, the dose should be reduced gradually.

The concentration of the drug in the blood should be monitored and corrected in hepatic and renal failure, while taking with other drugs. It is also important to consider fluctuations in blood levels of lamotrigine during pregnancy and postpartum ( Fetal Category FDA – C). During pregnancy, there is a decrease in the concentration of lamotrigine in the blood due to an increase in body weight and increased excretion under the influence of estrogens. This circumstance can lead to a worsening of the course of the disease. On the other hand, after childbirth, due to the reverse development of the above processes, physiological conditions are created for the appearance of signs of intoxication. Therefore, when planning pregnancy in women taking lamotrigine, it is advisable to determine the level of the drug in the blood and monitor it during pregnancy and after childbirth.

What is research used for?

Blood drug concentration monitoring;
drug interaction assessment;
diagnosis of overdose;
detection of violations of the drug regimen.

When is the examination scheduled?

If symptoms persist or worsen while taking lamotrigine;
while prescribing other anticonvulsants that affect the concentration of lamotrigine in the blood;
if the patient has impaired liver and kidney function;
before and during pregnancy and after childbirth;
for adverse events likely to be related to lamotrigine and suspected drug overdose.

What do the results mean?

Reference values: 4 – 10 µg/ml.

What can influence the result?

The concentration of lamotrigine in the blood increases:
when taking valproic acid;
for violations of the liver and kidneys.
Medicines that can reduce the concentration of lamotrigine in the blood: phenytoin, carbamazepine, phenobarbital, primidone, oral contraceptives, estrogens.

Important Notes

It is recommended to take blood for research 30-60 minutes before the scheduled intake of the drug.
Treatment, dose adjustment of this drug and concentration monitoring is carried out strictly under the supervision of a physician. It is unacceptable to independently change the mode of administration and dose of the drug.

Also recommended

[02-014] CBC

[06-003] Alanine aminotransferase (ALT)

[06-010] Aspartate aminotransferase (AST)

[06-036] Bilirubin total

[ 06-021] Serum creatinine

[15-001] Valproic acid

[15-006] Topiramate

Who orders the test?

Psychiatrist, psychotherapist, neurologist, clinical pharmacologist.

Literature

Adab N. Therapeutic monitoring of antiepileptic drugs during pregnancy and in the postpartum period: is it useful? CNS Drugs. 2006;20(10):791 – 800.
Cassels C. Lowering of Lamotrigine blood levels linked to increased seizure risk during pregnancy. Medscape. Nov 28, 2007.

Does lamotrigine cause weight loss. Lamotrigine and Weight Loss in Bipolar I Disorder: Effectiveness and Side Effects

Understanding Lamotrigine’s Role in Bipolar I Disorder Treatment

The Study: Comparing Lamotrigine, Lithium, and Placebo

Key Findings: Weight Changes Over Time

Mean Weight Changes at 52 Weeks

Clinically Significant Weight Changes

Lamotrigine’s Weight Profile: Stability and Neutrality

Comparing Lamotrigine to Lithium: Weight Effects and Implications

Lithium and Weight Gain

Lamotrigine’s Advantage

Clinical Implications of Lamotrigine’s Weight Profile

1. Treatment Selection

2. Long-term Adherence

3. Metabolic Health

4. Combination Therapy

Limitations and Future Directions

Practical Considerations for Patients and Clinicians

Monitoring Weight and Metabolic Parameters

Dosage Considerations

Combination Therapy

Patient Education

Lifestyle Factors

Conclusion: Lamotrigine’s Place in Bipolar Disorder Treatment

Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder

Affiliation

Authors

Affiliation

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Substances

Bipolar Medications and Weight Loss

Mood stabilizers

Antipsychotics

Lamotrigine

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