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Background: Lamotrigine is being prescribed increasingly for the treatment of bipolar disorder. In this article we review the current literature on the subject., Aim: To review the literature in order to assess the present position of lamotrigine in the treatment of bipolar disorder., Method: We reviewed the literature from 1985 to 2005 by means of PubMed and we also consulted the bibliographic references for the articles we found. In addition, we studied a review article by Goldsmith e. a. (2003)., Results: Although a considerable amount of research has been done, evidence for the efficacy of lamotrigine is limited. Lamotrigine was not effective in the treatment of acute mania. In only one of three studies was lamotrigine effective in the treatment of acute depression. In two extensive maintenance studies lamotrigine was found to be effective in preventing new depression episodes; however, the latter studies have such serious methodological weaknesses that the results provide only very limited evidence that lamotrigine is beneficial., Conclusion: In the guideline for the treatment of bipolar depression published by the NVVP (the Dutch Psychiatric Association; 2001), lamotrigine was mentioned as a possible treatment option for bipolar disorder and rapid cycling. In view of the results of randomised controlled trials (RCTS) that have been published so far, there is at present no reason to alter the status of lamotrigine.

Background: Until recently research into the efficacy of treatment of bipolar disorders focused mainly on the pharmacological treatment. Over the last few years more and more research has concentrated on the psychological treatments for bipolar disorders. aim To review published, controlled and randomised studies dealing with the efficacy of forms of psychotherapeutic treatment for bipolar disorders., Method: By searching Medline and Embase using the search terms, 'psychotherapy', 'cognitive (behavioural) therapy', 'family therapy' and 'psychoeducation' we found eight relevant reports of randomised, controlled trials, which described the interventions that were undertaken and recorded the relapse rates., Results: The following forms of treatment were investigated: Relapse-Prevention Plan, Cognitive Behavioural Therapy, Interpersonal and Social Rhythm Therapy, Family-Focused Treatment and Group Psychoeducation. These forms of treatment were used in addition to standard pharmacological treatment. The addition of psychotherapeutic treatment was found to reduce lower the relapse rate, to lead to less hospitalisation and to improve functioning., Conclusion: The authors recommend that patients with bipolar disorders be offered psychotherapeutic treatment because it is likely to lower the risk of relapse.

Patients with bipolar disorder who become pregnant may develop an episode during their pregnancy, but an episode is much more likely to occur during the postpartum period. Three case histories show the kinds of problems that can arise. Risk factors are mentioned and advice is given about the best ways of preventing such problems.

Unlabelled: For patients with a bipolar disorder who are pregnant or consider pregnancy, the following issues are of importance: Genetic counselling: genetic vulnerability is virtually certainly the basis of the occurrence of a bipolar disorder., Medication: discontinuation of the medication may lead to recurrence; continuation may cause intoxications in the woman and her child and congenital anomalies in the child. Alternatives to mood stabilizers can be applied; electroconvulsive therapy is a possibility as is medication with antidepressants, antipsychotics and benzodiazepines during acute episodes of mood disorder. Precautions for mother and child if mood-stabilizing treatment is continued: use sustained-release preparations, regularly check blood levels and thyroid function, administer vitamin K if necessary, perform ultrasonoscopy/examination of amniotic fluid, have the child delivered in hospital. Management of the newborn child: observation, determination of blood levels, regular checks of thyroid function, if necessary administration of vitamin K.

In two women aged 35 and 21 years, the initial diagnosis 'borderline personality disorder' was changed to 'bipolar disorder'. These disorders are separate entities with different therapy, but may resemble each other very much. It may be necessary to use heteroanamnesis and family anamnesis and to follow the patient for some time in order to establish whether there are mood disorders.

Two patients, a woman aged 32 and a man aged 27 years, were suffering from rapid cycling bipolar disorder (i.e. a course with four or more episodes a year). Hypothyroidism and the use of antidepressants may be involved in the development of such a disease course. Treatment with carbamazepine was successful in both patients. Patients suffering from rapid cycling bipolar disorder should be treated with lithium or carbamazepine, or a combination of these. Antidepressants should only be used with great caution.