Anticonvulsants in affective disorders

The current status of anticonvulsant drugs compared to other treatments for the management of affective disorders is evaluated. Data from controlled studies suggest that carbamazepine is superior to placebo, equivalent to neuroleptics, and comparable to lithium for mania, at least in relatively treatment-refractory patients. Carbamazepine may also be useful as an antidepressant and for prophylaxis. Valproate and clonazepam show promise in the treatment of mania and for prophylaxis, but the number of patients studied in controlled trials is small. Lorazepam and other benzodiazepines may be useful antimanic agents, and alprazolam exerts antidepressant effects, although its efficacy relative to the tricyclics is unclear. Electroconvulsive therapy (ECT) is effective for both mania and depression. Established treatments are carbamazepine and ECT for mania and ECT for depression. Still experimental are valproate and clonazepam for mania; carbamazepine and alprazolam for depression; and carbamazepine, ECT, valproate, and clonazepam for maintenance. Combinations with lithium appear promising but await double-blind trials. The place of other anticonvulsants in the treatment of affective disorders is unknown.