The use of anticonvulsants in manic-depressive illness

The role of anticonvulsants, particularly carbamazepine, in the treatment of manic-depressive illness has been the subject of multiple recent studies. Overall, carbamazepine has achieved a 55% to 65% clinical response in mania. The drug has a time course and efficacy rate similar to those of neuroleptics and lithium. Studies have not uncovered a relationship between clinical response and carbamazepine levels in plasma or the CSF, but a relationship was found in one study between the drug's principal metabolite and clinical response. Patients who are severely depressed, manic, anxious, or dysphoric before treatment appear to be good responders to carbamazepine. In one trial, 40% of the manic patients taking carbamazepine experienced a marked response. In depression a moderate or better response to carbamazepine was attained by 50% of patients in one study. Some evidence indicates that carbamazepine can potentiate the efficacy of other medications, including lithium.