Augmentation with Lamotrigine for Refractory Unipolar: Chart review 37 pt. Patients had been on varied of other meds with 9 yr hx depression. 48% much improved on CGI-I. Average response 7 weeks. 6 of 31 d/c in first 6 weeks due to side effects. Barbee, J Clin Psychiatry 02;63:737

No Augmentation Value for Lamotrigine in DB with Paroxetine: 40 unipolar depressed, DB PC. Adjunctive treatment with lamotrigine did not result in a significant difference in HAM-D total score at the endpoint of the study when compared with paroxetine alone. U Freiberg, Normann, J Clin Psychiatry 2002 Apr;63(4):337-44

Lamotrigine May Help Bipolar Depressed: In a questionable 6-week DB PC study of 45 adults with refractory bipolar (n = 35) or unipolar (n = 10) affective disorder using lamotrigine, gabapentin, or placebo monotherapy  with two subsequent cross-overs to the other agents, response rates much improved on CGI to lamotrigine (51%) exceeded those to gabapentin (28%) and placebo (21%). A positive response to lamotrigine monotherapy was associated with a bipolar diagnosis, fewer hospitalizations, fewer prior medication trials, and being male. Obrocea, NIMH, Biol Psychiatry 2002 Feb 1;51(3):253-60

Lamotrigine Helps, Gabapentin No Value in DB: DB PC 31 refractory unipolar and bipolar patients all given 6 week trial of lamotrigine, gabapentin, and placebo. NIMH, J Clin Psychopharmacol 2000 Dec;20(6):607-14

Topiramate (Topamax) May Have Helped Depression: In a 10-week DB PC study of 64 women with moderate Major Depression, those treated with topiramate had greater decreases on the Hamilton Depression Rating Scale (P=0.02), and the State-Trait Anger Expression Inventory (P<0.001), along with 9 pounds of added weight loss (P<0.001). Topiramate in treatment of depressive and anger symptoms in female depressive patients: A randomized, double-blind, placebo-controlled study. Nickel C, et al. Simbach/Inn, Germany. J Affect Disord. 2005 Aug;87(2-3):243-52. Ed: This is a small study, and topiramate has a high rate of side-effects and is very expensive. This study was very likely funded by the manufacturer.  I wouldn't start using Topamax for depression based on this one study.

Topiramate as Good as Bupropion (Wellbutrin): In an 8-week, single blind study of 36 bipolar, depressed, there was an 11 pound weight loss with topiramate vs. 3 pounds with bupropion. Six stopped topiramate due to side effects vs. 4 with bupropion. 175 mg/d topiramate vs. 250 mg/d bupropion were the average doses with 56% vs. 59% response rates. Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study. McIntyre RS, Mancini DA, et al. Bipolar Disord 2002 Jun;4(3):207-13

Divalproex (Depakote) Bipolar II Depression Rx Divalproex HS: 12-week open trial of DVPX monotherapy (mean dose 882 mg qhs, mean level 80.7 mug/ml) in nineteen (thirteen women, six men, mean age 29) bipolar II depressed outpatients. Eleven patients (six women, five men) were medication-naive (MN) and eight (seven women, one man) were mood stabilizer-naive (MSN), having had prior trials of antidepressants or stimulants. Mean illness and current depressive episode duration were 15.4 years and 11.8 weeks, respectively. DVPX was given as a single dose each evening starting with 250 mg at bedtime and increased by 250 mg at bedtime every 4 days until symptom relief or adverse effects were noted. (63%) responded. (63%) responded. Winsberg, Stanford, J Affect Disord 2001 Dec;67(1-3):207-12