Parts of this paper were initially presented at the American College of Neuropsychopharmacology (ACNP) Meeting, December 6–10, 2008, Hollywood, FL, USA; and at the Society of Biological Psychiatry Meeting, May 20–22, 2010, New Orleans, LA, USA.
Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double-blind, randomized, placebo-controlled trial
Article first published online: 13 FEB 2012
© 2012 John Wiley and Sons A/S
Volume 14, Issue 1, pages 64–70, February 2012
How to Cite
Anand, A., Gunn, A. D., Barkay, G., Karne, H. S., Nurnberger, J. I., Mathew, S. J. and Ghosh, S. (2012), Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double-blind, randomized, placebo-controlled trial. Bipolar Disorders, 14: 64–70. doi: 10.1111/j.1399-5618.2011.00971.x
Clinical Trials.gov #NCT00305578.
- Issue published online: 13 FEB 2012
- Article first published online: 13 FEB 2012
- Received 28 April 2011, revised and accepted for publication 12 September 2011
- bipolar depression;
- clinical trial;
- N-methyl-D-aspartate (NMDA) receptor
Anand A, Gunn AD, Barkay G, Karne HS, Nurnberger JI, Mathew SJ, Ghosh S. Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double-blind, randomized, placebo-controlled trial. Bipolar Disord 2012: 14: 64–70. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S.
Background: Recent studies indicate that modulation of glutamate neurotransmission is associated with antidepressant response. Lamotrigine, an anticonvulsant which decreases presynaptic glutamate release, has been shown to be effective in the depressive phase of bipolar disorder (BD-D); however, only 40–50% of patients have a full response. This pilot study investigated whether memantine, a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist approved for Alzheimer’s disease, can augment the effects of lamotrigine.
Methods: BD-D outpatients in a major depressive episode on a stable dose of lamotrigine (100 mg or more) were randomized to either memantine (starting dose of 5 mg increased up to 20 mg over four weeks, then 20 mg stable dose from four to eight weeks) or matching pill placebo for eight weeks. Patients were rated on the 17-item Hamilton Depression Rating Scale (HDRS) and other behavioral measures weekly.
Results: The eight-week repeated-measures mixed-effect model for HDRS was not significant for memantine (n = 14) versus placebo (n = 15). Exploratory mixed-effect analyses for the first four weeks, while the memantine dose was being titrated up every week, revealed a significant decrease in HDRS scores from baseline (p = 0.007).
Conclusion: This proof-of-concept study failed to show a statistically significant benefit of memantine augmentation of lamotrigine for patients with BD-D over eight weeks. However, memantine had an antidepressant effect early on in the treatment while its dose was being titrated up. Larger placebo-controlled studies are needed to ascertain optimal timing and dosing for memantine augmentation of lamotrigine in BD-D.