Dear Editor:
Lamotrigine is an anticonvulsant that acts by inhibiting the release of excitatory amino acids, aspartate and glutamate.1 The following case is of a patient who experienced a marked reduction in cocaine craving after being prescribed a starting dose of lamotrigine.
Case report. Mr. A, a 39-year-old African American male veteran with a 10-year history of cocaine abuse, was admitted to the psychiatry inpatient unit with suicidal ideas, agitation, and aggressive behavior secondary to cocaine intoxication. He had a history of depression and suicide attempts and had been prescribed various antidepressants. At the time of admission, he was prescribed quetiapine 50mg at night to help manage agitation and trazodone 50mg at bedtime to promote sleep.
Mr. A requested to try lamotrigine to help with cocaine cravings because one of his friends had noted a decrease in cocaine craving on lamotrigine. Mr. A was started on lamotrigine 25mg oral tablet once a day.
After two weeks of treatment, he reported a significant reduction in cocaine craving and a subjective feeling of wellbeing with no fear of “impending relapse.” His thoughts of abusing cocaine did not “have the emotional push behind them.” Dreams of abusing cocaine decreased from 4 to 5 times a week to only one dream in the first two months. At six months follow-up, the effects remained the same, with only one relapse at around the three-month time due to “peer pressure.” Otherwise, he remained abstinent and reported “a marked improvement in self confidence.”
Discussion. Researchers, such as Yee, et al.,2 Brown, et al.,3 and Margolin, et al.,4 have explored the role of lamotrigine in the management of cocaine dependence in comorbid conditions with higher doses up to 300mg/day. These studies did not report any differences in response based on race.
This response to low-dose lamotrigine in an African American man suggests a difference in response depending on the race. There is a need for clinical trials to establish the role of lamotrigine or other mood stabilizers in the management of cocaine abuse and to establish any differences in race.
With regards
M. Shamsi, MD
PGY-3 Department of Psychiatry University of Missouri, Columbia, Missouri shamsim@health.missouri.edu
C. Hemme, MD
Director Behavioral Health Services, HS Truman Memorial Veterans Hospital, Columbia, Missouri
B. Beitman, MD
Chairman Department of Psychiatry, University of Missouri, Columbia, Missouri
Contributor Information
M. Shamsi, PGY-3 Department of Psychiatry University of Missouri, Columbia, Missouri shamsim@health.missouri.edu.
C. Hemme, Director Behavioral Health Services, HS Truman Memorial Veterans Hospital, Columbia, Missouri.
B. Beitman, Chairman Department of Psychiatry, University of Missouri, Columbia, Missouri.
References
- 1.Post RM. In: Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Sadock BJ, Sadock VA, editors. Philadelphia, PA: Lippincott William and Wilkins; 2000. p. 1404. [Google Scholar]
- 2.Yee T, Perantie DC, Dhanani N, Sherwood B. Drug dreams in outpatients with bipolar disorder and cocaine dependence. J Nerv Mental Dis. 2004;192(3):238–42. doi: 10.1097/01.nmd.0000116466.31133.f1. [DOI] [PubMed] [Google Scholar]
- 3.Brown E, Nejtek VA, Perantie DC, et al. Lamotrigine in patients with bipolar discorder and cocaine dependence. J Clin Psychiatry. 2003;64(2):197–201. doi: 10.4088/jcp.v64n0213. [DOI] [PubMed] [Google Scholar]
- 4.Margolin A, Avants S, DePhilipps D, et al. A preliminary investigation of lamotrigine for cocaine abuse in HIV-seropositive patients. Am J Drug Alcohol Abuse. 1998;24(1):85–101. doi: 10.3109/00952999809001700. [DOI] [PubMed] [Google Scholar]