Abstracts

The onset and prevalence of epilepsy is higher in older adults than in any other age group. Advanced age is also associated with psychological changes such as cognition and mood in otherwise healthy adults. Depressive complaints are prevalent in up to 55% of people with epilepsy (PWE) across all age groups, with almost 30% meeting criteria for a major depressive disorder (MDD). Some antiepileptic drugs (AEDs) have both negative and positive psychotropic features. Lamotrigine (LTG) is approved for the maintenance treatment of bipolar I disorder to delay time to occurrence of mood episodes, especially depression. Data suggest that LTG has antidepressant effects in PWE with low-moderate levels of depression. This analysis evaluated the effects of LTG on mood in a subset of older patients with epilepsy and comorbid depressive symptoms from a larger study of adults. This was a multicenter open-label study. Lamotrigine was added onto a stable AED regimen in the adjunctive phase and became a single agent in the monotherapy phase. Patients were eligible for the study if they had epilepsy, exhibited depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) [ge] 12] but were excluded if they had a MDD as determined by a Mini International Neuropsychiatric Interview (M.I.N.I.) evaluation. Patients were evaluated using the Beck Depression Inventory (BDI-II), CES-D, and the Profile of Mood States (POMS) at baseline, at the end of the adjunctive phase (Week 19) and the monotherapy phase (Week 36). Analysis was done using paired t-tests. Forty older adults (24 women, 16 men) at least 50 years of age were evaluated out of a total study population of 159 PWE. A total of 24 patients completed the adjunctive phase and 18 completed the monotherapy phase. Results of the depression psychometrics used were as follows: Mean baseline, end of adjunctive (week 19) and monotherapy (week 36) scores for the BDI-II, 15.8, 12.8, 9.5; for the CES-D, 24.3, 15.3, 12.8; and for total POMS were 57.7, 34.2, 24.3 respectively. Except for the BDI-II at the end of the adjunctive phase, change scores were significant at p [lt]0.01. These results were similar to those of the entire study population whereby scores were 17.4, 11.6, 7.7 for the BDI-II; 24.4, 15.4, 11.5 for the CES-D and 56.2, 36.8 21.6 for total POMS. The most common adverse events were dizziness, headache, nausea and blurred vision which were similar in older adults compared with the overall study population. This subgroup of older adults presented with low-moderate levels of depressive symptoms. The addition of LTG to AED therapy demonstrated antidepressant activity in this group similar to that of the population as a whole. (Supported by GlaxoSmithKline Research and Development.)