The long-term management of bipolar disorders with lithium, carbamazepine, and antidepressants

Carbamazepine is gaining recognition as a valuable drug in the treatment of patients with bipolar disorders who fail to respond to lithium. Clinical experience in the treatment of 90 bipolar patients is described: 48% responded to lithium alone or in combination with other standard drug treatments. A subgroup of 34 lithium nonresponders were treated with carbamazepine; of these, 17 (50%) responded to carbamazepine and 5 responded to carbamazepine plus lithium, for a total response rate of 65%. Issues of side effects, blood levels, and compliance are discussed. These observations support the efficacy and safety of carbamazepine and suggest the need for well-controlled double-blind studies.