Objective  To observe the efficacy, safety, and compliance of lamotrigine combined with magnesium valproate in treating children with depressive episodes of bipolar disorder, and to explore the effects on thyroid hormone levels, brain-derived neurotrophic factor (BDNF), C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and plasma concentration of valproate.

Methods  The children with bipolar disorder diagnosed from January 2023 to February 2025 were selected, and divided into the observation group and control group. The control group was treated with magnesium valproate tablets, and the observation group was added lamotrigine in addition to the treatment given to the control group. Both groups were treated continuously for 8 weeks. The clinical efficacy, the Hamilton Depression Scale-24 (HAMD-24) score, Clinical Global Impression (CGI) assessment, thyroid hormone levels, BDNF, CRP, IL-1, IL-10 and TNF-α, daily average dose of magnesium valproate (D), blood concentration of valproate (C), C/D ratio, mean dosing interval (h), incidence of adverse reactions, and medication adherence and satisfaction scores in both groups was observed.

Results  A total of 100 children were included, 50 in each group. After treatment, the total effective rate of the observation group was 98.00% which was significantly higher than that of the control group (84.00%) (P<0.05). The serum free triiodothyronine (FT₃), free thyroxine (FT₄), BDNF and IL-10 in both groups increased compared to the previous (P<0.05), while HAMD-24 score, CGI score, thyroid-stimulating hormone (TSH), CRP, IL-1 and TNF-α decreased (P<0.05), and all indicators in the observation group were better than those in the control group (P<0.05). Both groups had no serious or new adverse drug reactions, and the incidence of total adverse reactions, the difference in the incidence of total adverse reactions was not statistically significant (P>0.05). There was no statistically significant difference in valproic acid blood concentrations between the two groups of children (P>0.05). The medication compliance score and satisfaction score of the observation group were significantly higher than those of the control group (P<0.05).

Conclusion  Combination of lamotrigine with magnesium valproate in children with depressive episodes of bipolar disorder improves treatment effective and clinical symptoms, promotes a rise in thyroid hormone and BDNF as well as improves inflammatory factors and increases medication adherence and satisfaction in children with a better safety profile.

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