ABSTRACT
The available literature on the use of anticonvulsants in the treatment of bipolar patients is summarized here, and perspectives and directions for future research and therapeutic development in this area are discussed. Carbamazepine and valproate have been shown to be effective in the acute antimanic treatment of bipolar disorder, and are the first-choice treatments for lithium-refractory patients. Valproate has been approved by the FDA in the United States as an antimanic agent. While the efficacy of these drugs in the acute treatment of the illness has been satisfactorily documented, double-blind randomized studies are still necessary to evaluate the long-term effectiveness of both anticonvulsants, although there are some controlled data to support their efficacy for maintenance, mostly for valproate. Newer anticonvulsants, such as gabapentin, lamotrigine, and topiramate have been investigated in the past few years as possible alternatives for bipolar individuals. Controlled doubleblind studies failed to support the antimanic effects of gabapentin. On the contrary, whereas the antimanic efficacy of lamotrigine needs to be confirmed in double-blind studies, this agent has been shown to be effective in the pharmacological management of the depressive phase of the illness, as well as a maintenance treatment, recently resulting on FDA approval for the maintenance treatment of bipolar disorder in the Unite States. Topiramate, due to induced weight loss, may represent a potential alternative for treatment-resistant bipolar patients with obesity or druginduced weight gain. However, its antimanic action is still unconfirmed as there is no controlled evidence to support its efficacy.
