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. 2017 Oct 8:4:21.
doi: 10.1186/s40479-017-0072-6. eCollection 2017.

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

Mary Ellen Trunko  1 , Terry A Schwartz  1 , Laura A Berner  1 , Anne Cusack  1 , Tiffany Nakamura  1 , Ursula F Bailer  1   2 , Joanna Y Chen  1 , Walter H Kaye  1   3
Affiliations

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

Mary Ellen Trunko et al. Borderline Personal Disord Emot Dysregul. .

Abstract

Background: There is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation.

Methods: This pilot open series evaluated lamotrigine, a mood stabilizer, in the treatment of patients with eating disorders who did not respond adequately to antidepressant medications. Nine women with anorexia nervosa- or bulimia nervosa-spectrum eating disorders in partial hospital or intensive outpatient dialectical behavior therapy (DBT)-based eating disorder treatment took lamotrigine for 147 ± 79 days (mean final dose = 161.1 ± 48.6 mg/day). Participants completed standardized self-report measures of emotion dysregulation and impulsivity after lamotrigine initiation and approximately biweekly thereafter. Mood and eating disorder symptomatology were measured at lamotrigine initiation and at time of final assessment.

Results: Lamotrigine and concurrent DBT were associated with large reductions in self-reported affective and behavioral dysregulation (ps < 0.01). Eating disorder and mood symptoms decreased moderately.

Conclusions: Although our findings are limited by the confounds inherent in an open series, lamotrigine showed initial promise in reducing emotional instability and behavioral impulsivity in severely dysregulated eating-disordered patients. These preliminary results support further investigation of lamotrigine for eating disorders in rigorous controlled trials.

Keywords: Anticonvulsants; Binge eating; Emotion dysregulation; Lamotrigine; Purging.

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Conflict of interest statement

Ethics approval and consent to participate

The Human Research Protections Program at the University of California, San Diego approved of the collection of data for this study. All participants provided written informed consent before completing assessments and consented to treatment including psychotropic medication.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CONSORT Flow Diagram for Lamotrigine Open Trial. Out of 14 enrolled patients, five were discontinued from the trial: one patient stopped lamotrigine after she developed a possible rash, one non-adherent participant reported to psychiatrists several months into the trial that she never started taking lamotrigine, and three were lost to follow up after discharging prematurely from our program. As none of the five discontinued patients completed 60 days of lamotrigine titration, they were excluded from the analysis. The final sample included nine patients who started lamotrigine at UCSD and took the medication for at least 60 days
Fig. 2
Fig. 2
BEST and ZAN-BPD Score Change Over Time. The Borderline Evaluation of Severity Over Time (BEST) score change over time is presented in panel a and the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) score change is shown in panel b. Days on lamotrigine at each assessment point are shown on the x axis and scores are shown on the y axis
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