Carbamazepine treatment of bipolar disorder: a retrospective evaluation of naturalistic long-term outcomes

Abstract

BackgroundCarbamazepine (CBZ) has been used in the treatment of bipolar disorder, both in acute mania and maintenance therapy, since the early 1970s. Here, we report a follow-up study of CBZ-treated bipolar patients in the Taipei City Psychiatric Centre.MethodsBipolar patients diagnosed according to the DSM-IV system and treated with CBZ at the Taipei City Psychiatric Centre had their charts reviewed to evaluate the efficacy and side effects of this medication during an average follow-up period of 10 years.ResultsA total of 129 bipolar patients (45 males, mean age: 45.7 ± 10.9 year) were included in the analysis of CBZ efficacy used alone (n = 63) or as an add-on after lithium (n = 50) or valproic acid (n = 11), or the both of them (n = 5). The mean age of disease onset was 24.6 ± 9.5 years. The mean duration of CBZ use was 10.4 ± 5.2 year. The mean dose used was 571.3 ± 212.6 mg/day with a mean plasma level of 7.8 ± 5.9 μg/mL. Mean body weight increased from 62.0 ± 13.4 kg to 66.7 ± 13.1 kg during treatment. The frequencies of admission per year before and after CBZ treatment were 0.33 ± 0.46 and 0.14 ± 0.30, respectively. The most common side effects targeted the central nervous system (24%), including dizziness, ataxia and cognitive impairment. Other common side effects were gastrointestinal disturbances (3.6%), tremor (3.6%), skin rash (2.9%), and blurred vision (2.9%). Eighty-eight patients (68.2%) were taking antipsychotics concomitantly. Ninety-six patients (74.4%) needed to use benzodiazepines concomitantly. Sixty-three (48.8%) patients had zero episodes in a 10-year follow-up period, compared to all patients having episodes prior to treatment. Using variable analysis, we found better response to CBZ in males than in females.ConclusionsCBZ is efficacious in the maintenance treatment of bipolar disorder in naturalistic clinical practice, either as monotherapy or in combination with other medications. CBZ is well tolerated by most patients in this patient group.

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

“…It has shown efficacy as monotherapy and as an adjunct to lithium in reducing the risk of recurrence, particularly of depression 4 19–21 . Carbamazepine is another option that has shown some efficacy predominantly as an adjunct,22 but due to its side effect burden, should be considered only after more readily-tolerated agents fail to yield benefits 3…”

Relationships between pharmacokinetic parameters of carbamazepine and therapeutic response in patients with bipolar disease

“…However, treatment with carbamazepine is associated with several side effects that complicate the use of the drug and necessitate therapeutic monitoring [2,3]. This monitoring allows the optimization of the therapeutic dose-response efficacy and the prevention or attenuation of the risk of relapse [4,5]. Despite the effectiveness of carbamazepine as a standard drug for bipolar treatment, important individual variations in the response to carbamazepine therapy were reported [2].…”

Prophylactic efficacy of lithium, valproic acid, and carbamazepine in the maintenance phase of bipolar disorder

“…Shortly thereafter, it was recognized that anticonvulsants, such as valproic acid (VPA), carbamazepine (CBZ), and lamotrigine could also act as mood stabilizers. Anticonvulsants and Li are currently recommended for BD prophylactic treatment (Lambert et al, 1966;Bowden et al, 2000;Chen and Lin, 2012).…”