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Case Reports in Medicine
Volume 2012, Article ID 736521, 5 pages
Case Report

Add-on Lamotrigine Treatment for Subsyndromal Depression after Manic or Mixed States in Bipolar Disorder Improved the Quality of Life

1Kimura Hospital, 6-19 Higashi-Honcho, Chuo-Ku, Chiba, Chiba-shi 260-0004, Japan
2Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan

Received 27 May 2012; Accepted 30 August 2012

Academic Editor: B. Carpiniello

Copyright © 2012 Katsumasa Muneoka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Two cases of patients experienced subsyndromal depression after manic or mixed hypomanic and depressive episodes due to bipolar I (case 1) and II (case 2) disorders prior to the use of lamotrigine. Case 1 showed episodes of mood switching induced by antidepressants and seasonal mood instability. Case 2 showed hippocampal atrophy and a persistent dull headache that preceded the use of lamotrigine. Both were successfully treated with add-on lamotrigine therapy, and the dull headache was effectively treated with olanzapine. Both patients improved in social activity and work performance after these add-on treatments. Thus, add-on treatment with lamotrigine alone or in combination with olanzapine was an effective strategy to improve the quality of life in bipolar depression. Subsyndromal depression that present after the disappearance of the manic or mixed state was suggested to be practical indication for the use of lamotrigine.