Correlates of antimanic response to carbamazepine

Nineteen acutely manic patients were studied in a double-blind trial of carbamazepine in doses averaging 1240 mg/day, achieving blood levels of 10.4 +/- 2.2 micrograms/ml. Clinical improvement in mood and psychomotor components of the manic syndrome was rapid in onset, generally parallel to that observed in previous patients treated with neuroleptics, and was associated with increases in the total hours of nighttime sleep. Compared to the seven nonresponders, the 12 patients who improved were significantly more manic during the baseline placebo period, tended to be more dysphoric, and were significantly more rapid cyclers over their entire course of illness as assessed by episodes in the year before NIMH admission (7.0 +/- 5.6 vs. 2.7 +/- 2.4 in the nonresponders). While improvement was robust in responders, it was not always complete, and some of these patients remained mildly to moderately symptomatic. All seven patients with a negative family history of affective illness in first degree relatives were responders, while those with a positive family history were equally divided. These preliminary data suggest that several predictors of poor response to lithium carbonate (manic severity, anxiety and dysphoria, rapid cycling, and negative family history) may be associated with good antimanic response to carbamazepine.