Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T07:40:31.022Z Has data issue: false hasContentIssue false
  • English
  • Français

Update on the use of new anticonvulsants as mood stabilisers

Published online by Cambridge University Press:  02 January 2018

Ian Maidment
Ian Maidment*
Affiliation:
Pharmacy Department Hellesdon Hospital, Drayton High Road, Norwich NR6 5BE
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Aims and method

The aim of the study was to assess and update the data related to the use of lamotrigine, gabapentia topiramate and tiagabine as mood stabilisers. The published trials and case reports were collated from searches of the Cochrane Collaboration, Medline and Micromedex from January 1985 to January 1999. The manufacturers were also contacted.

The search included other aspects of the usage of these anticonvulsants, such as side-effects and drug interactions.

Results

Most of the data are in the form of anecdotal case reports and small scale open studies. The majority of the trials lack a placebo arm and do not use standard rating scales or standard diagnostic criteria. The usefulness of the results is partly limited by the short durations and small sample sizes. Furthermore, it is often unclear whether concomitant medication was altered.

Therefore, any conclusion of effectiveness requires confirmation in double-blind placebo-controlled studies to eliminate any false-positive response due to bias, placebo effects or random variability. There is also possibility of false-negative selection bias, as the early data tends to relate to a more refractory population. The use of these newer anticonvulsants as mood stabilisers is currently under investigation in a clinical trial programme.

Clinical implications

There are no studies comparing the new anticonvulsants either with each other or with established agents. There is less evidence supporting the use of the newer anticonvulsants in bipolar disorders compared with established agents. The newer anticonvulsants should be used as third- or fourth-line agents. There is more data supporting the use of lamotrigine and gabapentin.

Type
Drug Information Quarterly
Information
Psychiatric Bulletin , Volume 23 , Issue 9: The Journal of Trends in Psychiatric Practice , September 1999 , pp. 554 - 558
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 1999 The Royal College of Psychiatrists

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.Google Scholar
Anonymous (1994) Gabapentin – a new antiepileptic drug. Drugs & Therapeutics Bulletin, 32, 29 30.CrossRefGoogle Scholar
Anonymous (1996a) Reminder Lamotrigine and serious skin reactions. Current Problems in Pharmacovigilance, 22, 12.Google Scholar
Anonymous (1996b) Topiramate – add-on drug for partial seizures. Drugs & Therapeutics Bulletin, 34, 62 64.Google Scholar
Association of the British Pharmaceutical Industry (1997) Data Sheet Compendium 1997–1998. London: Datapharm Publications Limited.Google Scholar
Bennet, J., Goldman, W. T. & Suppes, T. (1997) Gabapentin for treatment of bipolar and schizoaffective disorders (letter). Journal of Clinical Psychopharmacology, 17, 141 142.Google Scholar
Calabrese, J. R., Bowden, C. L., Sachs, G. S., et al (1999) A double-blind placebo-controlled study of lamotrigine monotherapy in out-patients with bipolar I depression. Journal of Clinical Psychiatry, 60, 79 88.Google Scholar
Dodrill, C. B., Arnett, J. L., Shu, V., et al (1998) Effects of tiagabine monotherapy on abilities, adjustment, and mood. Epilepsia, 39, 33 42.Google Scholar
Doose, D. R., Walker, S. A., Sachdeo, R., et al (1994) Steady-state pharmacokinetics of tegretol (carbamazepine) and topamax (topiramate) in patients with epilepsy on monotherapy and during combination therapy. Epilepsia, 35 (suppl. 8). S54.Google Scholar
Duncan, D., McConnell, H. W. & Taylor, D. (1998) Lamotrigine in bipolar affective disorder. Psychiatric Bulletin, 22, 630 632.Google Scholar
Elwes, R. D. E. & Binnie, C. D. (1996) Clinical pharmacokinetics of newer antiepileptic drugs. Clinical Pharmacokinetics, 30, 403 415.CrossRefGoogle ScholarPubMed
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766 771.Google Scholar
Gilman, J. T. (1995) Lamotrigine: an anti-epileptic agent for the treatment of partial seizures. Annals of Pharmacotherapy, 29, 144 151.Google Scholar
Guy, W. (ed.) (1976) ECDEU Assessment Manual for Psychopharmacology. Publication ADM 76–338. pp. 217 222. Rockville, MD: US Department of Health. Education and Welfare.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56 62.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278 296.Google Scholar
Knoll, J., Stegman, K. & Suppes, T. (1998) Clinical experience using gabapentin adjunctively in patients with a history of mania or hypomania. Journal of Affective Disorders, 49, 229 233.CrossRefGoogle ScholarPubMed
Kotler, M. & Matar, M. A. (1998) Lamotrigine in the treatment of resistant bipolar disorder. Clinical Neuropharmacology, 21, 65 67.Google Scholar
Kusumakar, V. & Yatham, L. N. (1997) An open study of lamotrigine in refractory bipolar depression. Psychiatry Research 72, 145 148.Google Scholar
Maidment, I. D. (1999) Lamotrigine – an effective mood stabiliser? Annals of Pharmacotherapy, in press.Google Scholar
Marcotte, D. (1998) Use of topiramate, a new anti-epileptic as a mood stabiliser. Journal of Affective Disorders, 50, 245 251.Google Scholar
McElroy, S. L., Soutullo, C. A., Keck, P. E., et al (1997) A pilot trial of adjunctive gabapentin in the treatment of bipolar disorder. Annals of Clinical Psychiatry, 9, 99 103.Google Scholar
Nassir Ghaemi, S., Katzow, J. J., Desai, S. P., et al (1998) Gabapentin treatment of mood disorders: a preliminary study. Journal of Clinical Psychiatry, 59, 426 429.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799 812.Google Scholar
Ramsay, R. E. (1994) Clinical efficacy and safety of gabapentin. Neurology, 44 (suppl. 5), S23 S30.Google Scholar
Richens, A. (1994) Safety of lamotrigine. Epilepsia, 35 (suppl. 5), S37 S40.CrossRefGoogle ScholarPubMed
Rush, A. J., Giles, D. E., Schlesser, M. A., et al (1986) The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Research 18, 65 87.Google Scholar
Ryback, R. & Ryback, L. (1995) Gabapentin for behavioural dyscontrol (letter). American Journal of Psychiatry, 152, 1399.Google Scholar
Ryback, R., Brodsky, L. & Munasifi, F. (1997) Gabapentin in bipolar disorder (letter). Journal of Neuropsychiatry, 9, 301.CrossRefGoogle Scholar
Schaffer, C. B. & Schaffer, L. C. (1997) Gabapentin in the treatment of bipolar disorder (letter). American Journal of Psychiatry, 154, 291 292.Google Scholar
Short, C. & Cooke, L. (1995) Hypomania induced by gabapentin (letter). British Journal of Psychiatry, 166, 679 680.Google Scholar
Sporn, J. & Sachs, G. (1997) The anticonvulsant lamotrigine in treatment-resistant manic-depressive illness. Journal of Clinical Psychopharmacology, 17, 185 189.Google Scholar
Stanton, S. P., Keck, P. E. & McElroy, S. L. (1997) Treatment of acute mania with gabapentin (letter). American Journal of Psychiatry, 154, 287.Google Scholar
Sterker, M., Berroushot, J. & Schneider, D. (1995) Fatal course of toxic epidermal necrolysis under treatment with lamotrigine. International Journal of Pharmacology and Therapeutics, 33, 595 597.Google Scholar
Sussman, N. (1997) Gabapentin and lamotrigine: alternative agents for the treatment of bipolar disorder. Psychopharmacology, 132, 25 42.Google Scholar
Warner, T., Patsalos, P. N., Prevett, M., et al (1992) Lamotrigine-induced carbamazepine-10,11–epoxide. Epilepsy Research 11, 147 150.Google Scholar
Young, R. C., Biggs, J. T., Ziegler, V. E., et al (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429 435.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.