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Does 'rebound mania' occur after stopping carbamazepine? A pilot study
1George MacKenzie House, Fulbourn Hospital, Cambridge, UK.
Journal of Psychopharmacology (Oxford, England)
|December 6, 2000
Summary
Withdrawal of lithium prophylaxis can cause rebound mania in bipolar disorder patients. This study found no evidence of a similar carbamazepine rebound effect, suggesting it may be a better option for poorly compliant individuals.
Area of Science:
- Psychiatry
- Pharmacology
- Neurology
Background:
- Lithium prophylaxis withdrawal in bipolar disorder is associated with 'rebound mania'.
- Carbamazepine is an alternative/adjunctive prophylactic treatment for bipolar disorder.
- No prior studies investigated carbamazepine withdrawal effects.
Purpose of the Study:
- To examine the effects of carbamazepine prophylaxis withdrawal in bipolar disorder patients.
- To determine if a 'rebound' effect occurs after carbamazepine cessation.
- To compare carbamazepine withdrawal effects with lithium withdrawal-induced rebound mania.
Main Methods:
- Retrospective case series study.
- Systematic search for bipolar disorder patients who stopped carbamazepine during remission.
- Case note review and patient interviews.
Main Results:
- Six patients were included in the case series.
- Four patients remained well for at least 3 months post-cessation.
- One patient experienced moderate depression; another resumed treatment after 1 month.
- No patients required hospitalization or experienced manic episodes within 3 months of stopping carbamazepine.
Conclusions:
- The study does not support the existence of a carbamazepine 'rebound' effect.
- Recurrence after carbamazepine withdrawal may be less severe than lithium rebound mania.
- Carbamazepine might be a preferable mood stabilizer for poorly compliant patients, but further research is needed.