[Anticonvulsants in the treatment of bipolar disorder]

Starting with carbamazepine and valproate in the eighties, several anticonvulsant have been established as a treatment option in bipolar disorder. They may constitute an alternative to lithium for prophylactic treatment as well as to classical and atypical antipsychotics for the treatment of acute mania. Only for the acute treatment of bipolar depression they could not demonstrate convincing results so far. However, not every anticonvulsant is at the same time a mood stabilizer; there are clear differences in efficacy and tolerability also within the group of anticonvulsants used in bipolar disorder. Nevertheless, and in contrast to epilepsy, combination treatment with several anticonvulsants is still rare in bipolar disorder, whereas combined treatment with lithium, antidepressants or antipsychotics is more common. This article is intended to give a comprehensive overview of the spectrum of efficacy, important side effects and clinical utility in bipolar disorder both for the older and new anticonvulsants, and refers the reader to the relevant literature.