Update: New Uses for Lithium and Anticonvulsants

Abstract

Anticonvulsants are being used clinically as monotherapy and adjuncts in mental illnesses other than affective disorders. This review focuses on the literature for anticonvulsants and lithium in substance use disorders, anxiety disorders, and schizophrenia. Given the abuse potential and other difficulties with prescribing benzodiazepines for alcohol and benzodiazepine withdrawal, anticonvulsants have been considered as an alternative. Promising therapeutic effects have been demonstrated in many of the anxiety disorders, with the greatest number of trials and positive results in posttraumatic stress disorder. Although anticonvulsant and lithium augmentation for schizophrenia is common in practice and has been studied in double-blind, randomized, controlled trials, the sum of the evidence has been inconclusive.

Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death

“…[1][2][3] Their off-label use is rapidly increasing as well. 4,5 The wide range of indications and common use of anticonvulsants in patients with or without psychiatric comorbidities make their safety an issue of great relevance.…”

Mood stabilizers increase prepulse inhibition in DBA/2NCrl mice

“…Another major therapeutic class used for treating bipolar disorder and schizophrenia is mood stabilizers (Rosenberg and Salzman 2007;Grunze 2008;Thase and Denko 2008). The prototypical mood stabilizer in bipolar disorder is lithium (Thase and Denko 2008).…”

“…Another antiepileptic drug (topiramate) that failed in clinical trials is nevertheless used off label as a mood stabilizer because of its ability to counteract weight gain associated with other medications (e.g., atypical antipsychotics). Lithium, valproic acid, carbamazepine, and lamotrigine are all used as add-on therapies in schizophrenia despite limited evidence for their efficacy in the treatment of psychosis (Rosenberg and Salzman 2007;Grunze 2008).…”

The adverse event profile of pregabalin: A systematic review and meta‐analysis of randomized controlled trials

“…Food and Drug Administration, 2010). Moreover, the number of indications and off‐label utilizations of common AEDs is continuously growing (Rosenberg & Salzman, 2007). Therefore, providing reliable information on the tolerability and safety profiles of these agents has a broad clinical relevance.…”