Carbamazepine and valproate in the maintenance treatment of bipolar disorder.
BACKGROUND
Carbamazepine and valproate are used in the treatment of acute bipolar mania and as maintenance treatments for bipolar disorder. We reviewed the available data from randomized clinical trials of these agents in bipolar disorder to assess their efficacy and tolerability in the maintenance phase of illness management.


METHODS
We conducted a MEDLINE search augmented by a manual search of bibliographies, textbooks, and abstracts from recent scientific meetings to identify studies of carbamazepine and valproate in the maintenance treatment of bipolar disorder.


RESULTS
Although a paucity of data exists from randomized, placebo-controlled trials, carbamazepine and valproate appear to prevent relapse as monotherapy in patients with bipolar disorder. Preliminary evidence of predictors of response to each respective agent has been identified. Combinations of carbamazepine and lithium and of valproate and olanzapine may have greater efficacy than monotherapy.


CONCLUSIONS
Although carbamazepine and valproate have been less well studied in maintenance treatment than lithium, each agent appears to have efficacy in this phase of illness management. However, for many patients, combination therapy may provide better long-term prevention of illness relapse and recurrence.
Keck
Paul E
PE
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA. paul.keck@UC.edu
McElroy
Susan L
SL
D000927:Anticonvulsants / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D010919:Placebos; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
D000927:Anticonvulsants; D010919:Placebos; D002220:Carbamazepine; D014635:Valproic Acid; D008094:Lithium