Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report


  • Drs Ketter and Rasgon have received research grant support and honoraria from GlaxoSmithKline and Abbott Laboratories, but these companies did not provide support for the work described in this manuscript. Ms Glenn is an employee of ChronoRecord Association, Inc., ChronoRecord software was provided by ChronoRecord Association, Inc.

Terence A. Ketter, MD, Stanford University School of Medicine, 401 Quarry Rd., Room 2124, Stanford, CA 94305-5723, USA. Fax: (650) 723 2507; e-mail:


Aims/Objectives:  To evaluate lamotrigine in a woman with a 30-year history of treatment-resistant menstrually-entrained rapid cycling bipolar II disorder with follicular phase depressive and luteal phase mood elevation symptoms.

Methods:  Lamotrigine was started at 5 mg/day and gradually increased up to 300 mg/day, while venlafaxine was tapered gradually and discontinued, and divalproex sodium 500 mg/day and levothyroxine 175 mcgm/day were continued. Daily self-reported mood ratings were obtained from the patient, using ChronoRecord software.

Results:  As lamotrigine was increased gradually, mood cycle amplitude attenuated. There was notable decrease in the severity and duration of depressive symptoms specifically during the follicular phase of the menstrual cycle. At the time of submission of this paper, the subject had remained euthymic for a total of 12 months.

Conclusion:  This case suggests the potential utility of lamotrigine in treatment-resistant menstrually-related rapid cycling bipolar disorder, and raises the possibility that lamotrigine might be able to treat pathological entrainment of mood with the menstrual cycle. Both of these issues merit systematic assessment.