Anticonvulsants and antipsychotics in the treatment of bipolar disorder

A number of recent advances in clinical psychopharmacology regarding anticonvulsant and new antipsychotic medications have important implications with respect to the treatment of patients who have bipolar disorder. The authors reviewed the available literature on the efficacy of the anticonvulsants valproate, carbamazepine, gabapentin, and lamotrigine for the treatment of bipolar disorder. They also reviewed the use of standard and new antipsychotic medications for the treatment of various aspects of the illness. Valproate and carbamazepine have been shown to be effective in the treatment of acute mania in controlled trials. Preliminary data suggest that these agents may differ in their time course of antimanic activity and predictors of response. Neither agent has been extensively studied in controlled trials in bipolar depression or as maintenance therapy, although carbamazepine has received the most systematic study in these areas. Gabapentin and lamotrigine are only now being evaluated in controlled trials in patients who have bipolar disorder. Antipsychotics are commonly used in the treatment of patients with acute mania and as maintenance treatment. However, the use of standard antipsychotics in acute mania is associated with a number of limitations. New antipsychotic agents may possess thymoleptic as well as antipsychotic activity, but they have not been studied in controlled trials in bipolar disorder.