Case report: successful riluzole augmentation therapy in treatment-resistant bipolar depression following the development of rash with lamotrigine
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Bipolar affective disorder is a common, severe, chronic and often life-threatening illness (Goodwin and Jamison 1990). Increasingly, it is recognized that the depressive phase of the illness contributes to much of the morbidity and mortality associated with bipolar disorder (Simpson and Jamison 1999). While treatments for acute unipolar depression have been extensively researched, few studies have examined the efficacy of somatic treatments for the acute phase of bipolar depression (Keck et al. 2003), and treatment with antidepressants remains controversial (Ghaemi et al. 2003; Goodwin 2003). Lamotrigine is a putative inhibitor of glutamate release through inhibition of voltage-dependant Na+ and Ca2+ channels, and is effective in bipolar depression (Calabrese et al. 1999). The FDA has recently approved lamotrigine for relapse prevention in bipolar I disorder. Although generally well tolerated, the development of a rare but serious rash may necessitate lamotrigine...