치료저항성 주요우울장애 환자의 라모트리진 강화요법 - 자연관찰연구

Lamotrigine Augmentation in Patients with Treatment-Resistant Major Depressive Disorder : A Naturalistic Study

  이번 연구는 임상 실제에서 치료저항성 주요우울장애 환자를 대상으로 8주 라모트리진 강화요법의 유용성을 평가한 자연경과연구이다. 전체 대상군에서 8주간 치료 후 유의한 우울증상의 호전이 관찰되었고, 반응군과 비반응군 간 임상증상 변화양상은 3주 이후 유의하게 구분되었다. 라모트리진 강화요법의 안전성도 관찰되었다. 라모트리진 강화요법의 임상효능과 반응군의 특성을 밝히기 위하여 대규모 전향적 통제연구가 필요하다.

&nbsp;&nbsp;Objective: Lamotrigine"s possible efficacy in the treatment of depressive disorders has been suggested. This naturalistic study investigated clinical response to lamotrigine augmentation in patients with treatment-resistant depression. Characteristics of the lamotrigine-responders were also explored. Methods: Clinical data from 40 lamotrigine-treated patients with treatment-resistant unipolar depression were analyzed. The subjects were diagnosed with DSM-Ⅳ major depressive disorder and resistant to at least 2 antidepressants. Efficacy of lamotrigine treatment was measured by the changes in mean scores of the Clinical Global Impression Severity subscale (CGI-S), which were extracted from the prospective mood chart and structured interviews. Response was defined as a decrease of at least 2 or more from baseline on the CGI-S. Untoward effects associated with lamotrigine treatment were also assessed through medical records. Results: Significant reduction in the CGI-S mean score was observed from baseline through 8 week lamotrigine augmentation in 40 patients with treatment-resistant unipolar depression (t=5.7, df=39, p＜.01), and the magnitude of treatment effect was large (r<SUB>effect size</SUB>=0.68). Drop-outs were mainly attributable to lamotrigine-associated rash (N=5). Greater rate of improvement was associated with responder group (N=14) compared to non-responder group (N=17) from week 3 onward. Conclusion : The results of current study lend support to the potential benefit of lamotrigine augmentation in a subpopulation of patients with treatment-resistant unipolar depression. Continuation of lamotrigine add-on for more than 3 weeks may be needed to assess clinical outcome. Lamotrigine augmentation was generally well-tolerated. Large scale, double-blind studies are necessary to confirm its use as an augmentation agent.