Treatment of Bipolar Depression and Anxiety

Introduction to Lamotrigine and Gabapentin

• The American Academy of Child and Adolescent Psychiatry recommends lamotrigine for maintenance treatment in bipolar disorder, as it has demonstrated efficacy specifically for bipolar depression 1, 2
• The American Academy of Child and Adolescent Psychiatry also notes that gabapentin has not been shown to be effective for anxiety disorders and should not be used for this indication 1, 2, 3

Established Indications for Gabapentin

• Gabapentin's evidence-based uses are limited to neuropathic pain conditions, such as painful diabetic neuropathy and postherpetic neuralgia, and seizure disorders, not anxiety 4
• For neuropathic pain, gabapentin requires careful dose titration due to nonlinear pharmacokinetics from saturable absorption 4

Treatment of Anxiety

• The Annals of Internal Medicine recommends using evidence-based treatments such as SSRIs, SNRIs, or benzodiazepines for acute management of anxiety 5, 6, 7
• When treating anxiety symptoms in patients with major depressive disorder, second-generation antidepressants show equivalent efficacy and are appropriate first-line choices 5, 6, 7