Reassessing Carbamazepine in the Treatment of Bipolar Disorder Clinical Implications of New Data

ABSTRACTThis monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions.Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight. *) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.

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Reassessing Carbamazepine in the Treatment of Bipolar Disorder Clinical Implications of New Data

CNS Spectrums ◽

10.1017/s1092852900023063 ◽

2005 ◽

Vol 10 (6) ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Terence A. Ketter ◽

David L. Ginsberg ◽

Hagop S. Akiskal ◽

Paul E. Keck ◽

Richard H. Weisler ◽

...

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Drug Interactions ◽

Bipolar Depression ◽

Panel Discussion ◽

Current Data ◽

Clinical Implications ◽

Good Tolerability ◽

Long Term Treatment

AbstractThis monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions.Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight.) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.

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Pharmacotherapy Update: Quetiapine use in Bipolar Disorder—What does the evidence tell us?

Clinical Medicine Therapeutics ◽

10.4137/cmt.s1136 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S1136

Author(s):

Mark Taylor ◽

Kirsty Mackay ◽

Polash Shajahan

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Large Scale ◽

Maintenance Treatment ◽

Bipolar Depression ◽

Mood Stabiliser ◽

Serious Illness ◽

Randomized Controlled ◽

Second Generation Antipsychotic

Bipolar disorder is a common and serious illness usually requiring long term medication. We critically review the available evidence surrounding the increasing use of quetiapine, a second generation antipsychotic, in both the acute and maintenance phases of bipolar disorder. Large scale, randomized controlled data supports the use of quetiapine in both acute mania and acute bipolar depression, as a safe and effective treatment and probably best used in combination with a traditional ‘mood stabiliser’ such as lithium or divalproex. Also, quetiapine monotherapy has been shown to be effective in bipolar depression. Two recently published studies also confirm that quetiapine in combination with either lithium or divalproex ‘adds value’ to the maintenance treatment of bipolar disorder in terms of delaying relapse compared to either lithium or divalproex alone. Quetiapine is generally well tolerated, although further work on long term weight gain and emergent diabetes would be helpful.

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Typical and atypical antipsychotics in bipolar disorder

Acta Neuropsychiatrica ◽

10.1017/s0924270800035559 ◽

2000 ◽

Vol 12 (3) ◽

pp. 115-119 ◽

Cited By ~ 9

Author(s):

R.W. Licht

Keyword(s):

Bipolar Disorder ◽

Atypical Antipsychotics ◽

Treatment Guidelines ◽

Bipolar Depression ◽

Term Treatment ◽

Advantages And Disadvantages ◽

Long Term Treatment ◽

Randomised Controlled ◽

Typical Antipsychotics

ABSTRACTBackground: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

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Treatment of bipolar depression

CNS Spectrums ◽

10.1017/s1092852912001009 ◽

2013 ◽

Vol 18 (4) ◽

pp. 177-187 ◽

Cited By ~ 4

Author(s):

Laura Musetti ◽

Claudia Del Grande ◽

Donatella Marazziti ◽

Liliana Dell'Osso

Keyword(s):

Bipolar Disorder ◽

Bipolar Depression ◽

Treatment Options ◽

Mood Stabilizers ◽

Term Outcome ◽

Long Term Outcome ◽

Increased Risk ◽

Long Term Treatment ◽

Antidepressant Use

Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder.

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Efficacy of Carbamazepine and Its Derivatives in the Treatment of Bipolar Disorder

Medicina ◽

10.3390/medicina57050433 ◽

2021 ◽

Vol 57 (5) ◽

pp. 433

Author(s):

Anna Grunze ◽

Benedikt L. Amann ◽

Heinz Grunze

Keyword(s):

Bipolar Disorder ◽

Drug Interactions ◽

Relapse Prevention ◽

Bipolar Depression ◽

Prophylactic Efficacy ◽

Medline Search ◽

Class A ◽

Prevention Studies ◽

Bipolar Patients

Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug–drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.

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