Lamotrigine therapy in treatment-resistant menstrually-related rapid cycling bipolar disorder: a case report

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Adult; Antimanic Agents; Bipolar Disorder; Chronobiology Phenomena; Cyclohexanols; *Drug Resistance; Female; Follicular Phase; Humans; Menstruation; Thyroxine; Triazines; Valproic Acid


Mental and Social Health | Psychiatry | Psychiatry and Psychology


AIMS/OBJECTIVES: To evaluate lamotrigine in a woman with a 30-year history of treatment-resistant menstrually-entrained rapid cycling bipolar II disorder with follicular phase depressive and luteal phase mood elevation symptoms.

METHODS: Lamotrigine was started at 5 mg/day and gradually increased up to 300 mg/day, while venlafaxine was tapered gradually and discontinued, and divalproex sodium 500 mg/day and levothyroxine 175 mcgm/day were continued. Daily self-reported mood ratings were obtained from the patient, using ChronoRecord software.

RESULTS: As lamotrigine was increased gradually, mood cycle amplitude attenuated. There was notable decrease in the severity and duration of depressive symptoms specifically during the follicular phase of the menstrual cycle. At the time of submission of this paper, the subject had remained euthymic for a total of 12 months.

CONCLUSION: This case suggests the potential utility of lamotrigine in treatment-resistant menstrually-related rapid cycling bipolar disorder, and raises the possibility that lamotrigine might be able to treat pathological entrainment of mood with the menstrual cycle. Both of these issues merit systematic assessment.

DOI of Published Version



Bipolar Disord. 2004 Oct;6(5):435-9. Link to article on publisher's site

Journal/Book/Conference Title

Bipolar disorders


At the time of publication, Wendy Marsh was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID