CNS Drugs

, Volume 21, Issue 1, pp 47–71

Thirty Years of Clinical Experience with Carbamazepine in the Treatment of Bipolar Illness

Principles and Practice

Authors

  • Robert M. Post
    • Bipolar Collaborative Network
    • Penn State School of Medicine
    • Department of Psychiatry and Behavioral SciencesStanford University School of Medicine
  • Thomas Uhde
    • Department of PsychiatryPenn State Milton S. Hershey Medical Center
  • James C. Ballenger
    • Department of PsychiatryMedical University of South Carolina
Review Article

DOI: 10.2165/00023210-200721010-00005

Cite this article as:
Post, R.M., Ketter, T.A., Uhde, T. et al. CNS Drugs (2007) 21: 47. doi:10.2165/00023210-200721010-00005

Abstract

Carbamazepine began to be studied in a systematic fashion in the 1970s and became more widely used in the treatment of bipolar disorder in the 1980s. Interest in carbamazepine has been renewed by (i) the recent US FDA approval of a long-acting preparation for the treatment of acute mania; (ii) studies suggesting some efficacy in bipolar depression; and (iii) evidence of prophylactic efficacy in some difficult-to-treat subtypes of bipolar illness. A series of double-blind controlled studies of the drug were conducted at the US National Institute of Mental Health from the mid-1970s to the mid-1990s. This review summarises our experience in the context of the current literature on the clinical efficacy, adverse effects and pharmacokinetic interactions of carbamazepine.

Carbamazepine has an important and still evolving place in the treatment of acute mania and long-term prophylaxis. It may be useful in individuals with symptoms that are not responsive to other treatments and in some subtypes of bipolar disorder that are not typically responsive to a more traditional agent such as lithium. These subtypes might include those patients with bipolar II disorder, dysphoric mania, substance abuse co-morbidity, mood incongruent delusions, and a negative family history of bipolar illness in first-degree relatives. In addition, carbamazepine may be useful in patients who do not adequately tolerate other interventions as a result of adverse effects, such as weight gain, tremor, diabetes insipidus or polycystic ovarian syndrome.

We review our clinical and research experience with carbamazepine alone and in combination with lithium, valproic acid and other agents in complex combination treatment of bipolar illness. More precise clinical and biological predictors and correlates of individual clinical responsiveness to carbamazepine and other mood stabilisers are eagerly awaited.

Copyright information

© Adis Data Information BV 2007