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[Is there a rationale in combining anticonvulsants for bipolar patients?]
Andreas Conca1, Renate Grohmann, Jan Di Pauli
1Abteilung der Psychiatrie I, Landeskrankenhaus Rankweil. andreas.conca@lkhr.at
Summary
Bipolar disorder treatment often requires multiple medications due to high recurrence and severity. This paper reviews the rationale and increasing incidence of using combined anticonvulsant mood stabilizers for better patient outcomes.
Area of Science:
- Psychiatry and Pharmacology
- Neuroscience
Context:
- Bipolar disorder presents with high recurrence, chronicity, and severity, often necessitating complex treatment strategies.
- Therapy-refractory cases and psychiatric comorbidities are common, leading to significant polypharmacy in over 40% of patients.
- Existing treatments face challenges due to diverse clinical manifestations of episodes.
Purpose:
- To evaluate the incidence of combined mood stabilizer prescriptions in bipolar disorder.
- To delineate the preclinical and clinical rationales supporting anticonvulsant combination therapy.
- To provide a framework for thoughtful anticonvulsant combination therapy.
Summary:
- The frequency of combination therapies using two or more anticonvulsants has risen from 4.5% to over 12% in the past decade.
- Preclinical findings from epilepsy research and clinical trials in bipolar disorder inform the use of these combinations.
- A rationale for judicious anticonvulsant combination therapy is presented, acknowledging treatment complexity and potential side effects.
Impact:
- Informs clinical practice regarding the growing trend of anticonvulsant polypharmacy in bipolar disorder.
- Highlights the need for evidence-based rationales to guide combination therapy decisions.
- Contributes to managing complex and therapy-refractory cases of bipolar disorder.
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