Phenytoin as an antimanic anticonvulsant: a controlled study.
OBJECTIVE
Phenytoin, a classical anticonvulsant, shares with antimanic anticonvulsants the property of blockade of voltage-activated sodium channels. The authors therefore planned a trial of phenytoin for mania.


METHODS
Patients with either bipolar I disorder, manic type, or schizoaffective disorder, manic type, entered a 5-week, double-blind controlled trial of haloperidol plus phenytoin versus haloperidol plus placebo. Of 39 patients, 30 completed at least 3 weeks and 25 completed 5 weeks.


RESULTS
Significantly more improvement was observed in the patients receiving phenytoin. Added improvement with phenytoin in scores on the Brief Psychiatric Rating Scale and Clinical Global Impression was seen in the patients with bipolar mania but not those with schizoaffective mania.


CONCLUSIONS
Blockade of voltage-activated sodium channels may be a common therapeutic mechanism of many anticonvulsants given for mania, and phenytoin may be a therapeutic option for some manic patients.
Mishory
A
A
Stanley Center for Bipolar Research, Ministry of Health Mental Health Center, Ben Gurion University of the Negev, Beersheva, Israel.
Yaroslavsky
Y
Y
Bersudsky
Y
Y
Belmaker
R H
RH
D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000494:pharmacology / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010672:Phenytoin / Q000494:pharmacology / Q000627:therapeutic use*; D010919:Placebos; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D015222:Sodium Channels / Q000187:drug effects; D016896:Treatment Outcome
D000927:Anticonvulsants; D018692:Antimanic Agents; D010919:Placebos; D015222:Sodium Channels; D010672:Phenytoin; D006220:Haloperidol