Hostname: page-component-77c89778f8-swr86 Total loading time: 0 Render date: 2024-07-23T04:15:49.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Lamotrigine-induced obsessive-compulsive disorder in patients with bipolar disorder

Published online by Cambridge University Press:  08 August 2018

Verinder Sharma  and
Minakshi Doobay
Verinder Sharma*
Affiliation:
Department of Psychiatry and Obstetrics & Gynecology, University of Western Ontario, London, Ontario, Canada Parkwood Mental Health Building, St. Joseph’s Health Care, London, Ontario, Canada
Minakshi Doobay
Affiliation:
Parkwood Mental Health Building, St. Joseph’s Health Care, London, Ontario, Canada
*
*Address for correspondence: Dr. Verinder Sharma, Parkwood Institute, Mental Health Care Building, 550 Wellington Road, London, ON N6C 0A7, Canada. (Email: vsharma@uwo.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Lamotrigine is a commonly used drug in the treatment of bipolar disorder. Although there are reports of its effectiveness in the management of bipolar disorder and comorbid obsessive-compulsive disorder (OCD), lamotrigine has also been associated with obsessionality in patients with bipolar disorder.

Methods

Charts of 8 patients with bipolar disorder who had de novo onset of obsessions and compulsions after the use of lamotrigine were reviewed. The Naranjo scale was used to assess the likelihood of patients developing OCD due to lamotrigine use.

Results

Two to 8 months after the initiation of lamotrigine, patients with no such prior history developed obsessions and compulsions meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for medication-induced OCD. In all except 1 patient, the symptoms resolved within a month of lamotrigine discontinuation.

Conclusions

Some patients with bipolar disorder may develop OCD after initiation of lamotrigine. Due to the inherent limitations of a case series, the findings should be interpreted with caution.

Keywords

Antipsychoticbipolar disordercomorbiditylamotrigineobsessive compulsive disorder
Type
Original Research
Information
CNS Spectrums , Volume 24 , Issue 4 , August 2019 , pp. 390 - 394
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors would like to thank Christine Baczynski at Parkwood Institute, London, Ontario, Canada for her assistance in manuscript preparation.

References

References:

Lamictal [package insert]. Greenville, NC: DSM Pharmaceuticals, Inc; 2009.Google Scholar
Yatham, LN, Kennedy, SH, Parikh, SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15(1): 1–44.CrossRefGoogle ScholarPubMed
Reid, JG, Gitlin, MJ, Altshuler, LL. Lamotrigine in psychiatric disorders. J Clin Psychiatry. 2013; 74(7): 675–684.CrossRefGoogle ScholarPubMed
Bruno, A, Mico, U, Pandolfo, G, et al. Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. J Psychopharmacol. 2012; 26(11): 1456–1462.CrossRefGoogle ScholarPubMed
Khalkhali, M, Aram, S, Zarrabi, H, Kafie, M, Heidarzadeh, A. Lamotrigine augmentation versus placebo in serotonin reuptake inhibitors-resistant obsessive-compulsive disorder: a randomized controlled trial. Iran J Psychiatry. 2016; 11(2): 104–114.Google ScholarPubMed
Poyurovsky, M, Glick, I, Koran, LM. Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms. J Psychopharmacol. 2010; 24(6): 861–866.CrossRefGoogle ScholarPubMed
Geddes, JR, Calabrese, JR, Goodwin, GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry. 2009; 194(1): 4–9.CrossRefGoogle ScholarPubMed
Kemp, DE, Gilmer, WS, Fleck, J, Dago, PL. An association of intrusive, repetitive phrases with lamotrigine treatment in bipolar II disorder. CNS Spectr. 2007; 12(2): 106–111.CrossRefGoogle ScholarPubMed
Kuloglu, M, Caykoylu, A, Ekinci, O, Yilmaz, E. Lamotrigine-induced obsessional symptoms in a patient with bipolar II disorder: a case report. J Psychopharmacol. 2009; 23(8): 1001–1003.CrossRefGoogle Scholar
Lombroso, CT. Lamotrigine-induced tourettism. Neurology. 1999; 52(6): 1191–1194.CrossRefGoogle ScholarPubMed
Sotero de Menezes, MA, Rho, JM, Murphy, P, Cheyette, S. Lamotrigine-induced tic disorder: report of five pediatric cases. Epilepsia. 2000; 41(7): 862–867.CrossRefGoogle ScholarPubMed
Zaatreh, M, Tennison, M, D’Cruz, O, Beach, RL. Anticonvulsants-induced chorea: a role for pharmacodynamics drug interaction? Seizure. 2001; 10(8): 596–599.CrossRefGoogle ScholarPubMed
Szmulewics, AG, Valerio, MP, Smith, JM. Obsessive-compulsive symptoms in adjunctive therapy with lamotrigine in clozapine-medicated patients. Schizophr Res. 2015; 166(1-3): 364–365.CrossRefGoogle Scholar
Alkın, T, Onur, E, Özerdem, A. Co-occurrence of blepharospasm, tourettism and obsessive–compulsive symptoms during lamotrigine treatment. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2007; 31(6): 1339–1340.CrossRefGoogle Scholar
Lee, SA, Lee, HW, Heo, K, et al. Cognitive and behavioural effects of lamotrigine and carbamazepine monotherapy in patients with newly diagnosed or untreated partial epilepsy. Seizure. 2011; 20(1): 49–54.CrossRefGoogle ScholarPubMed
Naranjo, CA, Busto, U, Sellers, EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2): 239–245.CrossRefGoogle ScholarPubMed
Lykouras, L, Alevizos, B, Michalopoulou, P, Rabavilas, A. Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27(3): 333–346.CrossRefGoogle ScholarPubMed
Stamouli, S, Lykouras, L. Quetiapine-induced obsessive-compulsive symptoms: a series of five cases. J Clin Psychopharmacol. 2006; 26(4): 396–400.CrossRefGoogle ScholarPubMed
Tranulis, C, Potvin, S, Gourge, M, Leblanc, G, Mancici-Marie, A, Stip, E. The paradox of quetiapine in obsessive-compulsive disorder. CNS Spectr. 2005; 10(5): 356–361.CrossRefGoogle ScholarPubMed
Brakoulias, V, Starcevic, B, Belloch, A, et al. Comorbidity, age of onset and suicidality in obsessive-compulsive disorder (OCD): an international collaboration. Compr Psychiatry. 2017; 76: 79–86.CrossRefGoogle Scholar
Ruscio, AM, Stein, DJ, Chiu, WT, Kessler, RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010; 15(1): 53–63.CrossRefGoogle ScholarPubMed
Zaninotto, L, Solmi, M, Veronese, N, et al. A meta-analysis of cognitive performance in melancholic versus nonmelancholic unipolar depression. J Affect Disord. 2016; 201: 15–24.CrossRefGoogle Scholar
Fergus, TA, Valentiner, DP, McGrath, PB, Jencuis, S. Shame- and guilt-proneness: relationships with anxiety disorder symptoms in a clinical sample. J Anxiety Disord. 2010; 24(8): 811–815.CrossRefGoogle Scholar
Amerio, A, Stubbs, B, Odone, A, Tonna, M, Marchesi, C, Ghaemi, SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review and meta-analysis. J Affect Disord. 2015; 186: 99–109.CrossRefGoogle ScholarPubMed
Rosenberg, DR, Mirza, Y, Russell, A, et al. Reduced anterior cingulate glutamatergic concentrations in childhood OCD and major depression versus healthy controls. J Am Acad Child Adolesc Psychiatry. 2004; 43(9): 1146–1153.CrossRefGoogle ScholarPubMed
Yücel, M, Wood, SJ, Wellard, RM, et al. Anterior cingulate glutamate–glutamine levels predict symptom severity in women with obsessive-compulsive disorder. Aust N Z J Psychiatry. 2008; 42(6): 467–477.CrossRefGoogle ScholarPubMed
Wu, K, Hanna, GL, Rosenberg, DR, Arnold, PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav. 2012; 100(4): 726–735.CrossRefGoogle ScholarPubMed
Cheung, H, Kamp, D, Harris, E. An in vitro investigation of the action of lamotrigine on neuronal voltage-activated sodium channels. Epilepsy Res. 1992; 13(2): 107–112.Google Scholar
Ostadhadi, S, Ahangari, M, Nikoui, V, et al. Pharmacological evidence for the involvement of the NMDA receptor and nitric oxide pathway in the antidepressant-like effect of lamotrigine in the mouse forced swimming test. Biomed Pharmacother. 2016; 82: 713–721.CrossRefGoogle ScholarPubMed
Çökmüş, FP, Aşçıbaşı, K, Öztekin, S, Demet, MM. Relationship of levetiracetam and obsessive-compulsive disorder: a case report. Psychiatry and Clinical Psychopharmacology. 2017; 27(3): 325–327.Google Scholar
Ozkara, C, Ozmen, M, Erdogan, A, Yalug, I. Topiramate related obsessive-compulsive disorder. Eur Psychiatry. 2005; 20(1): 78–79.CrossRefGoogle ScholarPubMed
El-Mallakh, RS, Gao, Y, Jeannie Roberts, R. Tardive dysphoria: the role of long term antidepressant use in-inducing chronic depression. Med Hypotheses. 2011; 76(6): 769–773.CrossRefGoogle ScholarPubMed
Sharma, V. Treatment resistance in unipolar depression: is it an iatrogenic phenomenon caused by antidepressant treatment of patients with a bipolar diathesis? Med Hypotheses. 2006; 67(5): 1142–1145.CrossRefGoogle ScholarPubMed