Use of carbamazepine in psychiatric disorders

Use of carbamazepine for the treatment of psychiatric disorders is reviewed. Carbamazepine's mechanism of action may be related to inhibition of kindling (repeated subtherapeutic electrical stimulation) in the temporal lobe and limbic system. In most published studies, carbamazepine was useful in affective disorders, especially in patients with bipolar manic disorders. In controlled, double-blind studies in patients with primary affective or schizoaffective disorders, carbamazepine significantly decreased manic symptoms and showed some antidepressant effect. Synergistic effects have been observed when carbamazepine is used with lithium. Carbamazepine has been reported to decrease symptoms in patients with aggression, dyscontrol syndromes, schizophrenia, and alcohol withdrawal syndrome, but few of these studies have been controlled, comparative trials; carbamazepine may be useful in patients with these disorders who do not respond to conventional therapies. Beneficial effects of carbamazepine in psychiatric disorders are usually observed with doses of 400-1600 mg/day and serum concentrations of 8-12 micrograms/mL. Carbamazepine is useful alone or in combination with other agents for bipolar affective disorders, especially in patients who are intolerant of or unresponsive to lithium. Serum carbamazepine concentration, hematological profile, and serum electrolytes should be monitored carefully to minimize the risk of toxicity.