Carbamazepine prophylaxis in refractory affective disorders: a focus on long-term follow-up.
Twenty-four patients with refractory affective disorders who were taking carbamazepine were followed in an open-label fashion for an average of 4 years. Carbamazepine, usually in combination with lithium and other previously ineffective medications, reduced the number and severity of manic and depressive episodes. An overall illness index of morbidity (duration x severity) decreased 72% in the first year and 66% in the second year of carbamazepine treatment. One-half of the patients (N = 11) who were followed for more than 2 years showed a pattern of continued improvement (stable); the other half showed loss of prophylaxis (escape). Those showing the escape pattern had a more rapidly deteriorating course of illness in the 4 years before the study than those showing the stable improvement. Clinical and mechanistic implications of these findings are discussed, including the phenomenon of contingent tolerance as a possible explanation for the emergence of loss of efficacy in a subgroup of patients.
Post
R M
RM
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892.
Leverich
G S
GS
Rosoff
A S
AS
Altshuler
L L
LL
D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D002220:Carbamazepine / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008094:Lithium / Q000008:administration & dosage*; D016651:Lithium Carbonate; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales
D016651:Lithium Carbonate; D002220:Carbamazepine; D008094:Lithium