Anticonvulsants and Antipsychotics in the Treatment of Bipolar Disorder

A number of recent advances in clinical psychopharmacology regarding anticonvulsant and newantipsychotic medications have important implications with respect to the treatment of patients whohave bipolar disorder. The authors reviewed the available literature on the efficacy of the anticonvulsantsvalproate, carbamazepine, gabapentin, and lamotrigine for the treatment of bipolar disorder.They also reviewed the use of standard and new antipsychotic medications for the treatment of variousaspects of the illness. Valproate and carbamazepine have been shown to be effective in the treatmentof acute mania in controlled trials. Preliminary data suggest that these agents may differ in theirtime course of antimanic activity and predictors of response. Neither agent has been extensively studiedin controlled trials in bipolar depression or as maintenance therapy, although carbamazepine hasreceived the most systematic study in these areas. Gabapentin and lamotrigine are only now beingevaluated in controlled trials in patients who have bipolar disorder. Antipsychotics are commonlyused in the treatment of patients with acute mania and as maintenance treatment. However, the use ofstandard antipsychotics in acute mania is associated with a number of limitations. New antipsychoticagents may possess thymoleptic as well as antipsychotic activity, but they have not been studied incontrolled trials in bipolar disorder.