Mood disorders in the psychoneurologic borderland: three cases of responsiveness to carbamazepine

Aj, Kessler; Ne, Barklage; Jw, Jefferson

doi:10.1176/ajp.146.1.81

Cited by 18 publications

(2 citation statements)

References 11 publications

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“…Therefore, it may be suggested that carbamazepine responders may have an atypical bipolar disorder, characterized by mood-incongruent delusions and co-morbidity. Older studies had suggested a good response to carbamazepine in bipolar disorder patients with concomitant structural brain abnormalities and pathologies revealed by EEG recording [22]. It is not known whether the clinical features of responders to carbamazepine are similar to those with another mood-stabilizing anticonvulsant drug, valproate.…”

Section: Clinical Features Of Responders To Mood Stabilizersmentioning

confidence: 99%

Genetic Influences on Response to Mood Stabilizers in Bipolar Disorder

Rybakowski

2013

CNS Drugs

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Mood stabilizers form a cornerstone in the long-term treatment of bipolar disorder. The first representative of their family was lithium, still considered a prototype drug for the prevention of manic and depressive recurrences in bipolar disorder. Along with carbamazepine and valproates, lithium belongs to the first generation of mood stabilizers, which appeared in psychiatric treatment in the 1960s. Atypical antipsychotics with mood-stabilizing properties and lamotrigine, which were introduced in the mid-1990s, form the second generation of such drugs. The response of patients with bipolar disorder to mood stabilizers has different levels of magnitude. About one-third of lithium-treated patients are excellent responders, showing total prevention of the episodes, and these patients are clinically characterized by an episodic clinical course, complete remission, a bipolar family history, low psychiatric co-morbidity and a hyperthymic temperament. It has been suggested that responders to carbamazepine or lamotrigine may differ clinically from responders to lithium. The main phenotype of the response to mood stabilizers is a degree of prevention against recurrences of manic and depressive episodes during long-term treatment. The most specific scale in this respect is the so-called Alda scale, where retrospective assessment of lithium response is scored on a 0–10 scale. The vast majority of data on genetic influences on the response to mood stabilizers has been gathered in relation to lithium. The studies on the mechanisms of action of lithium and on the neurobiology of bipolar disorder have led to the identification of a number of candidate genes. The genes studied for their association with lithium response have been those connected with neurotransmitters (serotonin, dopamine and glutamate), second messengers (phosphatidyl inositol [PI], cyclic adenosine-monophosphate [cAMP] and protein kinase C [PKC] pathways), substances involved in neuroprotection (brain-derived neurotrophic factor [BDNF] and glycogen synthase kinase 3-β [GSK-3β]) and a number of other miscellaneous genes. There are no published pharmacogenomic studies of mood stabilizers other than lithium, except for one study of the X-box binding protein 1 (XBP1) gene in relation to the efficacy of valproate. In recent years, a number of genome-wide association studies (GWAS) in bipolar disorders have been performed and some of those have also focused on lithium response. They suggest roles for the glutamatergic receptor AMPA (GRIA2) gene and the amiloride-sensitive cation channel 1 neuronal (ACCN1) gene in long-term lithium response. A promise for better elucidating the genetics of lithium response has been created by the formation of the Consortium on Lithium Genetics (ConLiGen) to establish the largest sample, to date, for the GWAS of lithium response in bipolar disorder. The sample currently comprises more than 1,200 patients, characterized by their response to lithium treatment according to the Alda scale. Preliminary results from this international stud...

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Section: Clinical Features Of Responders To Mood Stabilizersmentioning

confidence: 99%

Genetic Influences on Response to Mood Stabilizers in Bipolar Disorder

Rybakowski

2013

CNS Drugs

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“…Augmentation with lithium in four small, uncontrolled studies improved the response rate of psychotic depression, especially bipolar psychotic depression, to combination therapy [4]. In one report, open augmentation of antidepressant-antipsychotic combination therapy with carbamazepine was effective in 3 patients [105]. There has been more systematic interest in brief augmentation with mifepristone, an antagonist of the progesterone receptor and the glucocorticoid receptor type II, which has a low affinity for cortisol and helps terminate the stress response [19].…”

Section: Treatmentmentioning

confidence: 99%

Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Dubovsky

Ghosh

Serotte

et al. 2020

Psychother Psychosom

107

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Psychotic depression was initially considered to be at one end of a continuum of severity of major depression. Subsequent experience demonstrated that psychosis is an independent trait that may accompany mood disorders of varying severity. While much has been learned about the impact of severe mood congruent delusions and hallucinations on the course and treatment response of depression, less is known about fleeting or mild psychosis, mood incongruent features, or psychotic symptoms that reflect traumatic experiences. Acute treatment of psychotic unipolar depression generally involves the combination of an antidepressant and an antipsychotic drug or electroconvulsive therapy. There is inadequate information about maintenance treatment of unipolar psychotic depression and acute and chronic treatment of psychotic bipolar disorder. Decision-making therefore still must rely in part on clinical experience.

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Anticonvulsant response in a case of anorexia nervosa and bipolar disorder associated with right-sided brain injury

Shedlack

Pope

1992

Int. J. Eat. Disord.

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The authors present a case of anorexia nervosa and subsequent mania both preceded by remote right‐sided head injury in a young man. In spite of the apparent lack of neurologic sequelae in this case, metabolic brain imaging revealed persistent cerebral physiologic dysfunction in the right hemisphere. Furthermore, both anorexic and affective syndromes resolved with anticonvulsant treatment. The authors suggest that anorexia and bipolar affective disorder in this patient may be linked to right‐sided cerebral dysfunction.

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Mood disorders in the psychoneurologic borderland: three cases of responsiveness to carbamazepine

Cited by 18 publications

References 11 publications

Genetic Influences on Response to Mood Stabilizers in Bipolar Disorder

Genetic Influences on Response to Mood Stabilizers in Bipolar Disorder

Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Anticonvulsant response in a case of anorexia nervosa and bipolar disorder associated with right-sided brain injury

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