Bipolar Depression Clinical Trial
Official title:
Lamotrigine Therapy in the Treatment of Geriatric Bipolar Depression: An Evaluation of Markers of Cerebral Energy Metabolism
We propose to study the efficacy and tolerability of lamotrigine in the treatment of older adults with bipolar depression and to compare measures of brain energy metabolism between older subjects with bipolar depression and healthy age-matched controls in order to better understand treatment response in geriatric bipolar depression.
We will use MRI techniques and neuropsychological testing to investigate potential markers
of treatment response in elderly bipolar depressed patients receiving lamotrigine and
age-matched, non-depressed controls.
We intend to test these hypotheses:
1. At least 50% of older subjects with bipolar depression will respond treatment with
lamotrigine as evidenced by a 50% reduction on the Montgomery Asberg Rating Scale
(MADRS). In addition, treatment with lamotrigine will be safe and well tolerated as
evidenced by a drop-out rate of less than 10% due to adverse effects.
2. Compared with healthy age-matched, non-demented, non-depressed controls, subjects with
geriatric bipolar depression will demonstrate abnormalities in cerebral energy
metabolism as assessed by elevated levels of glutamate and lactate, and decreased
levels of NAA, using 1H MRS at 4T.
3. Successful treatment with lamotrigine in geriatric bipolar depression will result in
decreases in lactate and glutamate, and elevations in NAA.
4. Baseline measures of executive functioning and information processing speed (measured
by performance on the Wisconsin Card Sorting Test (WCST), Trails A and B and Stroop
tests) will be impaired in subjects with geriatric bipolar depression compared with
healthy controls. These measures will improve with successful treatment with
lamotrigine and correlate with improvements in markers of cerebral energy metabolism
(lactate, glutamate, NAA).
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