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Mexiletine in treatment-resistant bipolar disorder

A Schaffer1, A J Levitt, R T Joffe

  • 1Department of Psychiatry, Sunnybrook Health Science Center, 2075 Bayview Avenue, Room FG46, University of Toronto, Toronto, Canada.

Journal of Affective Disorders
|March 10, 2000
PubMed
Abstract

Insights

Mexiletine shows promise for treatment-resistant bipolar disorder. This study found it effective in reducing mood symptoms in patients who did not respond to other treatments.

Area of Science:

  • Psychiatry
  • Pharmacology
  • Neurology

Background:

  • Bipolar disorder is a complex mood disorder often requiring multiple treatment strategies.
  • Treatment resistance is a significant challenge in managing chronic bipolar disorder.
  • Mexiletine, an antiarrhythmic drug, possesses anticonvulsant and analgesic properties with potential neuropsychiatric applications.

Purpose of the Study:

  • To evaluate the efficacy and safety of mexiletine in patients with treatment-resistant bipolar disorder.
  • To assess mexiletine's impact on mood symptom severity in a difficult-to-treat population.

Main Methods:

  • An open-label study involving 20 subjects with rapid-cycling bipolar disorder.
  • Participants had previously failed standard treatments like lithium, valproic acid, and carbamazepine.
  • Weekly assessments included mexiletine dosing, blood levels, and the Hamilton Depression Rating Scale (HAM-D) and Manic State Rating Scale (MSRS).

Main Results:

  • Thirteen subjects completed the 6-week study, with mexiletine doses ranging from 200-1200 mg/day.
  • A significant reduction in the Burden of Mood Symptoms (BMS) was observed: 46% showed a full response (≥50% BMS reduction) and 15% a partial response (25-49% BMS reduction).
  • Notably, all 5 subjects experiencing mixed or manic states achieved a full or partial response.

Conclusions:

  • Mexiletine may represent a viable and safe therapeutic option for individuals with highly treatment-resistant, chronic bipolar disorder.
  • The findings suggest mexiletine's potential utility in managing severe mood episodes in this population.
  • Further investigation through randomized, controlled trials is necessary to validate these preliminary results.

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