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Update on the use of new anticonvulsants as mood stabilisers

  • Ian Maidment (a1)
Abstract
Aims and method

The aim of the study was to assess and update the data related to the use of lamotrigine, gabapentia topiramate and tiagabine as mood stabilisers. The published trials and case reports were collated from searches of the Cochrane Collaboration, Medline and Micromedex from January 1985 to January 1999. The manufacturers were also contacted.

The search included other aspects of the usage of these anticonvulsants, such as side-effects and drug interactions.

Results

Most of the data are in the form of anecdotal case reports and small scale open studies. The majority of the trials lack a placebo arm and do not use standard rating scales or standard diagnostic criteria. The usefulness of the results is partly limited by the short durations and small sample sizes. Furthermore, it is often unclear whether concomitant medication was altered.

Therefore, any conclusion of effectiveness requires confirmation in double-blind placebo-controlled studies to eliminate any false-positive response due to bias, placebo effects or random variability. There is also possibility of false-negative selection bias, as the early data tends to relate to a more refractory population. The use of these newer anticonvulsants as mood stabilisers is currently under investigation in a clinical trial programme.

Clinical implications

There are no studies comparing the new anticonvulsants either with each other or with established agents. There is less evidence supporting the use of the newer anticonvulsants in bipolar disorders compared with established agents. The newer anticonvulsants should be used as third- or fourth-line agents. There is more data supporting the use of lamotrigine and gabapentin.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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BJPsych Bulletin
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Update on the use of new anticonvulsants as mood stabilisers

  • Ian Maidment (a1)
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