Anticonvulsants in bipolar disorder.

OBJECTIVE

To review the literature on the effectiveness of anticonvulsant drugs in the management of bipolar disorder.

METHODS

A selective review of the literature.

RESULTS

Valproate is an effective drug, alone or in combination, for mania, but has limited benefit in bipolar depression. Although valproate is widely used in maintenance therapy of bipolar disorder, and secondary analyses suggest benefit, in the largest randomised maintenance trial there was only a trend favouring valproate. Lamotrigine has benefit in bipolar depression and maintenance, but not in mania. Carbamazepine is effective in mania. Other anticonvulsant drugs have been tried in mania, but with mixed results.

CONCLUSIONS

Valproate, lamotrigine and carbamazepine have a valuable place in the management of bipolar disorder.