Comparison of the antimanic efficacy of carbamazepine and chlorpromazine: A double-blind controlled study

The Lithium Ion: A Foundation for Psychopharmacological Specificity

“…Several controlled studies corroborated carbamazepine's effectiveness in the acute treatment of mania and perhaps prophylaxis of the disorder (Okuma et al 1979(Okuma et al , 1990Coxhead et al 1992;Lusznat et al 1988;Small et al 1991;Watkins et al 1987). Most studies found it to be comparable to lithium in effectiveness, except for three studies (Okuma et al 1981;Lerer et al 1987;Watkins et al 1987).…”

What makes a drug a primary mood stabilizer?

“…38 The efficacy of carbamazepine in the treatment of acute mania was superior to placebo in one crossover trial, 39 and comparable to lithium 40,41 and chlorpromazine 42,43 in comparison studies. Three small placebo-controlled studies found carbamazepine to have efficacy as monotherapy or in conjunction with lithium in patients with bipolar depression.…”

“…47 Interpretation of the results of the only placebo-controlled trial is limited by the use of adjunctive antimanic and antidepressant medications for breakthrough symptoms during the trial. 48 Two comparison trials with lithium were recently completed. 49,50 In the first study, patients receiving carbamazepine required significantly more adjunctive medications for breakthrough symptoms and experienced significantly more side effects leading to treatment discontinuation.…”

How can we classify “mood stabilizers” with different properties?

“…Early studies by Okuma et al [31,32] revealed the antimanic effects of CBZ in both the acute and maintenance treatment of bipolar mania, and these effects have recently been reconfirmed by randomized controlled studies of extended-release carbamazepine monotherapy in acute manic/mixed episodes [33,34], although efficacy in relapse prevention for manic episodes was found to be lower than that of Li [35]. However, according to the guidelines of the APA [15], NICE [16] and CANMAT [11], CBZ has been regarded only as the second-line option for treatment of the acute phase of bipolar mania due to concerns about intolerance to CBZ and pharmacokinetic interactions with CBZ.…”