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TREATMENT OF BIPOLAR DISORDER IN CHILDREN AND ADOLESCENTS - PART 4

Tham khảo tài liệu 'treatment of bipolar disorder in children and adolescents - part 4', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | 116 DIAGNOSIS AND TREATMENTS atory neurotransmitters particularly glutamate and aspartate Ketter Wang Becker Nowakowska Yang 2003 . Lamotrigine also inhibits serotonin reuptake suggesting that it might possess antidepressant properties. In 2003 the FDA approved lamotrigine for the maintenance treatment of bipolar I disorder in adults to delay the time to occurrence of mood episodes depression mania hypomania mixed episodes in patients treated for acute mood episodes with standard therapy. Several prospective studies in adults with bipolar disorder suggest that lamotrigine may be beneficial for the treatment of mood especially depressive symptoms in bipolar disorder Bowden et al. 2003 Calabrese et al. 1999 . Chang Saxena and Howe 2006 published an 8-week open-label trial of lamotrigine alone or as adjunctive therapy for the treatment of 20 adolescents ages 12-17 years mean age 15.8 years with bipolar disorders who were experiencing a depressive or mixed episode. The mean final dose was 131.6 mg day and 84 of these participants were rated as much or very much improved on the Clinical Global Improvement CGI scale. Larger placebo-controlled studies of lamotrigine in bipolar children and adolescents are needed. Dosing It is critical to follow the revised dosing guidelines for lamotrigine to avoid serious rashes. These guidelines can be found at http www.lamictal.com epilepsy hcp dosing pediatric_dosing.html. The starting dose of lamotrigine for an adolescent not on valproate is 25 mg day for 2 weeks with a gradual titration to 200-400 mg day. Laboratory Studies Prior to starting lamotrigine a patient s CBC differential platelet count and liver function tests should be checked. Adverse Events The most common side effects of lamotrigine are dizziness tremor somnolence nausea and headache. Rashes develop in 12 of patients and typically within the first 8 weeks of lamotrigine therapy. Rarely severe cutaneous reactions such as Stevens-Johnson syndrome and toxic epidermal .