Effects of Carbamazepine and Lithium on Affective Disorders

Okuma, Takashi

doi:10.1159/000118969

Cited by 114 publications

(65 citation statements)

References 7 publications

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“…In one acute mania study (Post et al 1987) and several prophylaxis studies (Okuma et al 1973;Post et al 1983;Elphick 1985), a high percentage of response was observed in rapid-cycling patients. However, when rapidcycling patients were compared with non-rapid-cycling patients in the recent studies of Okuma (1993), andDenicoff et al (1994, andunpublished observations) in our group, both found a higher prophylactic response rate to carbamazepine in non-rapid cycling patients. Okuma's data are revealing in that the 53% response rate to carbamazepine in those patients with a history of rapid cycling (compared with 76% in those without) is still substantially higher than the 30% response rate observed for lithium in patients with a history of rapid cycling (compared with 64% in those without such a history).…”

Section: Potential Correlates Of Response To the Mood Stabilizersmentioning

confidence: 41%

The place of anticonvulsant therapy in bipolar illness

et al. 1996

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With the increasing recognition of lithium's inadequacy as an acute and prophylactic treatment for many patients and subtypes of bipolar illness, the search for alternative agents has centered around the mood stabilizing anticonvulsants carbamazepine and valproate. In many instances, these drugs are effective alone or in combination with lithium in those patients less responsive to lithium monotherapy, including those with greater numbers of prior episodes, rapid-cycling, dysphoric mania, co-morbid substance abuse or other associated medical problems, and patients without a family history of bipolar illness in first-degree relatives. Nineteen double-blind studies utilizing a variety of designs suggest that carbamazepine, or its keto-congener oxcarbazepine, is effective in acute mania; six controlled studies report evidence of the efficacy of valproate in the treatment of acute mania as well. Fourteen controlled or partially controlled studies of prophylaxis suggest carbamazepine is also effective in preventing both manic and depressive episodes. valproate prophylaxis data, although based entirely on uncontrolled studies, appear equally promising. Thus, both drugs are widely used and are now recognized as major therapeutic tools for lithium-nonresponsive bipolar illness. The high-potency anticonvulsant benzodiazepines, clonazepam and lorazepam, are used adjunctively with lithium or the anticonvulsant mood stabilizers as substitutes or alternatives for neuroleptics in the treatment of manic breakthroughs. Preliminary controlled clinical trials suggest that the calcium channel blockers may have antimanic or mood-stabilizing effects in a subgroup of patients. A new series of anticonvulsants has just been FDA-approved and warrant clinical trials to determine their efficacy in acute and long-term treatment of mania and depression. Systematic exploration of the optimal use of lithium and the mood-stabilizing anticonvulsants alone and in combination, as well as with adjunctive antidepressants, is now required so that more definitive treatment recommendations for different types and stages of bipolar illness can be more strongly evidence based.

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Section: Potential Correlates Of Response To the Mood Stabilizersmentioning

confidence: 41%

The place of anticonvulsant therapy in bipolar illness

et al. 1996

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“…Retrospective analyses of small studies [61,62] suggested efficacy of CBZ in RC patients. However, the largest retrospective study analysing 215 patients over 2 years gave no evidence of efficacy in RC patients both for CBZ and lithium [63]. This view is supported by a recent double-blind study comparing lithium and CBZ.…”

Section: Valproatementioning

confidence: 99%

Clinical Relevance and Treatment Possibilities of Bipolar Rapid Cycling

et al. 2002

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Bipolar rapid cycling (RC) is defined as 4 or more affective episodes within 1 year. It has been postulated that RC is related to a poor response to lithium, to the same extent as mixed episodes or other atypical symptoms of the illness. This article reviews the current status of alternative pharmacological or otherwise supportive therapies of RC. Biological parameters and characteristics of the illness associated with RC like gender prevalence in women, hyperthyroidism, catecholamine-O-methyltransferase allele, the influence of sleep, different subtypes of bipolar disorder and the risk of antidepressantinduced cycling will be discussed in detail.

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“…Com relação ao tratamento profilático, carbamazepina apresentou taxa de resposta de 57% para depressão e 59% para mania. Segundo Okuma (1993) 136 , pacientes com predominância de sintomas maníacos durante o curso da doença, ciclos não circulares, início precoce dos sintomas e sintomas atípicos tendem a apresentar boa resposta farmacológi-ca ao uso da carbamazepina, enquanto história atual ou passada de ciclagem rápida indica má resposta terapêutica com o uso deste fármaco.…”

Section: Tratamentos Da Ciclagem Rápidaunclassified

Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

Machado‐Vieira

Schwartzhaupt²,

Frey

et al. 2003

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃOO Transtorno do Humor Bipolar (THB) caracteriza-se por oscilações do humor que causam prejuízos significativos no âmbito biopsicossocial, com critérios específicos para seus subdiagnósticos (DSM-IV). O surgimento de novos fármacos com propriedade de estabilizar o humor, o refinamento diagnóstico, as estimativas de uma maior prevalência, o risco de suicídio, assim como os prejuízos sociais causados para o indivíduo portador do transtorno, sua família e a sociedade enfatizam a importân-cia de cada vez mais este transtorno ser estudado de forma sistemática, continuada e críti-ca. Este artigo avalia criticamente as opções já estudadas para tratamento farmacológico dos diferentes subtipos de THB, avaliando sua eficácia para as indicações específicas, bem como as perspectivas de novos estudos com fárma-cos que ainda apresentam resultados limitados, especialmente devido à não sistematização dos estudos clínicos feitos até o presente momento. FÁRMACOS UTILIZADOS E MECANISMOS DE AÇÃO LítioO lítio interfere no metabolismo do inositol trifosfato, responsável pela liberação do cálcio de seus depósitos intracelulares, possivelmente através da inibição de enzimas na rota de formação do inositol2,3. Há também outras hipóteses que justificam seu uso como estabilizador do humor:-por sua similaridade com outros elementos (sódio, potássio, cálcio e magnésio), eleva Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

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Effects of Carbamazepine and Lithium on Affective Disorders

Cited by 114 publications

References 7 publications

The place of anticonvulsant therapy in bipolar illness

The place of anticonvulsant therapy in bipolar illness

Clinical Relevance and Treatment Possibilities of Bipolar Rapid Cycling

Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

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