Carbamazepine is an anticonvulsant used primarily in the treatment of seizure disorders such as epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability. Carbamazepine can also be used for the treatment of mania.

What is the evidence for carbamazepine as a treatment for bipolar disorder?

Moderate quality evidence suggests medium-sized effects of greater improvement in acute mania symptoms with carbamazepine than with placebo or topiramate. There was a large effect of greater improvement in acute mania symptoms with tamoxefin than with carbamazepine. There was more discontinuation of treatment with carbamazepine than with olanzapine.

Low quality evidence is unable to determine the benefits of carbamazepine over placebo for acute depression.

Also see the topic on relapse prevention.

November 2021

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Gabapentin is an anticonvulsant used primarily in the treatment of seizure disorders such as epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability.

What is the evidence for gabapentin as a treatment for bipolar disorder?

Moderate to low quality evidence suggests no differences between gabapentin and placebo for the treatment of mania symptoms.

Low quality evidence is unable to determine differences between groups for treatment discontinuation; an indication of tolerability.

November 2021

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Lamotrigine is an anticonvulsant used primarily in the treatment of epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability. In bipolar disorder, lamotrigine is used mainly for the treatment of depression.

What is the evidence for lamotrigine as a treatment for bipolar disorder?

Compared to placebo, high quality evidence finds a small effect of fewer relapses with lamotrigine to any mood state in stable patients. Moderate to high quality evidence suggests a small effect of greater improvement in depression symptoms, but not mania symptoms, with mono or adjunctive lamotrigine, and no differences in adverse events, including switching to mania.

Compared to other medications, moderate to high quality evidence suggests lamotrigine was less effective than tamoxefin, risperidone, haloperidol, or olanzapine for acute mania symptoms. Moderate to low quality evidence suggests fewer relapses with quetiapine than with lamotrigine, but lamotrigine was better tolerated than carbamazepine or lithium + valproate. There was more discontinuation with lamotrigine than with olanzapine, and more switching to mania with lamotrigine than with quetiapine or ziprasidone.

Moderate quality evidence suggests the rate of adverse dermatological reaction with lamotrigine is around 8.6%, with rates of Stevens-Johnson syndrome/toxic epidermal necrolysis, in particular, being around 0.02%.

There were no differences in symptoms or adverse events when lamotrigine was compared to lithium, olanzapine + fluoxetine, trancylpromine, citalopram, or inositol.

Also see the topic on relapse prevention.

November 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

November 2021

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Licarbazepine is an anticonvulsant used primarily in the treatment of epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability.

What is the evidence for licarbazepine as a treatment for bipolar disorder?

Moderate quality evidence suggests licarbazepine is less effective than tamoxefin or risperidone for acute mania symptoms. There may be more discontinuation of treatment with licarbazepine than with olanzapine. There were no significant differences in acute mania symptoms between treatment with licarbazepine and placebo or other medications.

November 2021

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Since the 1960s, lithium has become a mainstay of treatment for bipolar disorders. It has been recommended for both the treatment of acute mania and for the augmentation of antidepressants in depression.

What is the evidence for lithium as a treatment for bipolar disorder?

Symptoms

Moderate to high quality evidence finds medium-sized effects of greater improvement in acute mania symptoms with lithium than with placebo or topiramate, although there was a large effect of greater improvement in acute mania symptoms with tamoxefin than with lithium. No benefit was found for depression severity or for response to treatment for lithium over placebo or quetiapine, and no differences between groups were found for rates of switching to mania.

Moderate quality evidence finds small to medium-sized effects for the following predictors of lithium response (in order of descending effect size): a mania-depression sequence rather than a depression-mania sequence, no rapid cycling, having a family history of bipolar disorder, low body mass index, no psychotic symptoms, fewer mood episodes prior to lithium treatment, shorter prelithium illness duration, and later age of onset of bipolar disorder. Having a family history of lithium response and fewer hospitalisations prior to lithium treatment may also predict lithium response.

Relapse

Moderate quality evidence finds the recurrence of any mood episode is 39.8%, the recurrence of a depressive episode is 25.6%, and the recurrence of manic/hypomanic or mixed episodes is 18.5% with lithium maintenance treatment.

Moderate to high quality evidence finds a small to medium-sized benefit of lithium for preventing relapse to mania when compared to placebo, carbamazepine, lamotrigine or valproate. There may also be some benefit for preventing relapse to depression when lithium is compared to placebo.

Moderate quality evidence finds lithium + valproate, lithium + imipramine, or lithium + oxcarbazepine may be more effective than placebo for any relapse prevention (small to medium-sized effects). There were fewer relapses with lithium with or without additional valproate or oxcarbazepine, than with imipramine.

Other outcomes

Moderate quality evidence finds a small association between increased lithium levels in drinking water and reduced suicide and psychiatric hospitalization rates. Moderate to high quality evidence find self-harm may be reduced with lithium when compared to placebo or carbamazepine. There were no differences when lithium was compared to lamotrigine, olanzapine, divalproex, or quetiapine.

Lithium use during pregnancy was associated with small increased risks of any congenital anomaly, cardiac congenital anomalies, and a medium increased risk of more spontaneous abortion compared to no lithium use in any psychiatric disorder. Note that the findings for cardiac congenital anomalies and spontaneous abortion were not significant when lithium use in bipolar patients was compared to no lithium use only in bipolar patients. There were no increased risks of preterm birth or low birth weight.

There was less weight gain with lithium than with antipsychotics or other mood stabilisers, and no differences in weight pre-post treatment with lithium. However, Lithium may cause tremor and somnolence and increased serum creatinine levels. Placebo was better tolerated than lithium or lithium + valproate.

Also see the topic on relapse prevention.

October 2021

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Oxcarbamazepine is an anticonvulsant used primarily in the treatment of seizure disorders such as epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability.

What is the evidence for oxcarbazepine as a treatment for bipolar disorder?

Low quality evidence is unable to determine the benefits or harms of oxcarbazepine over placebo, valproate, or carbazepine (as an adjunctive to lithium) for acute bipolar disorder.

Also see the topic on relapse prevention.

November 2021

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Pregabalin is a medication primarily used to treat epilepsy and neuropathic pain. It has also been tested for people with treatment-resistant bipolar disorder.

What is the evidence for pregabalin for treatment-resistant bipolar disorder?

Low quality evidence is unable to determine the effects of pregabalin for treatment-resistant bipolar disorder due to a lack of large, randomised trials.

November 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

November 2021

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Topriamate is an anticonvulsant medication primarily used to treat epilepsy and migrane headaches. It has also been tested for people with bipolar disorder.

What is the evidence for topriamate for bipolar disorder?

Moderate quality evidence showed no significant differences in mania or mixed symptoms following treatment with topiramate or placebo for up to 12 weeks. There was greater improvement in mania and mixed symptoms with lithium than with topiramate. There were no differences in side effects between topiramate and placebo or lithium.

November 2021

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