Anticonvulsants for treatment of manic depression
Donald G. Vidt, MD
Alan W Bakst, PharmD, RPH
Gustavo A. Delucchi, MD
Joseph R. Calabrese, MDAddress reprint requests to J.R.C., Department of Psychiatry, University Hospitals of Cleveland, Case Western Reserve University, 2040 Abington Road, Cleveland, Ohio 44106.
Although lithium remains the treatment of choice for manic depression, it is now well recognized that 2 0 %–4 0% of patients either do not tolerate the drug or their disease does not respond to it. This subgroup of patients accounts for a substantial majority of the morbidity that accompanies this illness. For this reason, alternatives to lithium therapy will have a significant clinical impact. In a great majority of cases, the rapid-cycling variant of this disorder accounts for the resistance to lithium treatment. Recently, a growing body of literature has suggested that several medications routinely used in the management of seizure disorders, particularly carbamazepine and valproate, have therapeutic mood-altering properties. These drugs have been evaluated in numerous drug trials using open, double-blinded, longitudinal, and (in the case of carbamazepine) randomized designs. The authors comment on the phenomenology of manic depression and review the literature on use of anticonvulsants in the management of lithium-resistant manic depression.