Review Article

CNS Drugs

, Volume 16, Issue 8, pp 549-562

First online:

Newer Antiepileptic Drugs in Bipolar Disorder

Rationale for Use and Role in Therapy
  • Kathryn J. MacdonaldAffiliated withMood Disorder Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University Email author 
  • , L. Trevor YoungAffiliated withHamilton Regional Mood Disorder Program, St. Joseph’s Healthcare, Centre for Mountain Health Services

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Abstract

Antiepileptic drugs (AEDS) are used regularly in the treatment of patients with bipolar disorders. Carbamazepine and valproic acid (sodium valproate) are effective as antimanic treatments, and the success of these medications has prompted investigation of other AEDs as possible treatments in patients with mood disorders.

Lamotrigine appears to be the most promising of the newer AEDs with respect to effects in mood disorders. Current evidence suggests efficacy of this drug both as monotherapy and as an adjunctive agent in bipolar depression, and studies are underway to clarify its efficacy in mood stabilisation and rapid cycling, as currently available data are equivocal. Use of gabapentin is not as well supported in the literature, although data from open trials using it as an adjunctive agent suggest that it may be helpful in patients with bipolar depression. There have been some open trials and case reports supporting the use of topiramate as an adjunctive agent for the treatment of mania; however, data from controlled trials are not yet available.

Further controlled trials of lamotrigine, gabapentin or topiramate as mono-therapy and adjunctive treatment are needed to clarify their potential roles in the treatment of patients with mood disorders.