The use of benzodiazepines in the treatment of manic-depressive illness.
The benzodiazepine clonazepam was approved for the treatment of epilepsy in 1976. To study its use in acute mania, the author compared clonazepam with lithium in a crossover trial. Clonazepam proved more effective than lithium in controlling the symptoms of mania and caused fewer manifestations of parkinsonism. Associated side effects included ataxia, drowsiness, and behavioral changes. No treatment-emergent depression was observed. Neither clonazepam nor any other benzodiazepine is recommended in schizoaffective or schizophrenic disorders because of the high risk of dependence in those patients, in contrast to manic-depressives. For the maintenance treatment of bipolar disorder, lithium is recommended as the initial agent, with L-tryptophan added if concomitant medication is needed. Clonazepam can then be added as the anticonvulsant, if necessary. In the treatment of acute mania, clonazepam is recommended for the first week of treatment, and lithium is added in the beginning of the second week, thus avoiding the use of neuroleptics.
D000208:Acute Disease; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D002998:Clonazepam / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008140:Lorazepam / Q000627:therapeutic use; D010302:Parkinson Disease, Secondary / Q000139:chemically induced; D011897:Random Allocation; D012559:Schizophrenia / Q000188:drug therapy
D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D002220:Carbamazepine; D002998:Clonazepam; D008094:Lithium; D006220:Haloperidol; D008140:Lorazepam