Switching from other agents to extended-release carbamazepine in acute mania.
BACKGROUND
There is a dearth of available knowledge relating to the efficacy of switching from one psychotropic agent to another in treating patients with acute mania.


METHODS
This is a post hoc analysis of data from two randomized, placebo-controlled trials of carbamazepine extended-release capsules (CBZ-ERC) in the treatment of mania, to evaluate the efficacy of CBZ-ERC in patients previously nonresponsive to lithium (n 5 40), olanzapine (n 5 38), or valproate (VPA, n 5 77).


RESULTS
In patients previously on lithium, Young Mania Rating Scale (YMRS) scores improved significantly from baseline to end point (27.4 6 SD 3.5 vs. 15.8 6 11.1; P 5 .0002). In patients previously on VPA or olanzapine, YMRS scores significantly improved in both CBZ-ERC- and placebo-treated groups (VPA: CBZ-ERC, P , .0001; placebo, P 5 .0002; olanzapine: CBZ-ERC, P , .0001; placebo, P 5 .0054). Improvement in YMRS was significantly greater in CBZ-ERC-treated patients versus placebo in subjects previously nonresponsive to lithium (CBZ-ERC 11.6 6 10.3 vs. placebo 4.0 6 11.2, P 5 .03), or VPA (CBZ-ERC 10.8 6 11.9 vs. placebo 5.7 6 9.2; P 5 .04), and trending to be greater for those previously nonresponsive to olanzapine (olanzapine 13.2 6 9.3 vs. placebo 7.3 6 9.7, P 5 .06).


CONCLUSIONS
CBZ-ERC is an effective therapy for bipolar patients previously nonresponsive to lithium or valproate. Medication switch is frequently associated with symptom improvement.
El-Mallakh
Rif S
RS
Department of Psychiatry and Behavioral Sciences, University of Louisvilile School of Medicine, Louisville, KY, USA. rselma01@louisville.edu
Ketter
Terence A
TA
Weisler
Richard H
RH
Hirschfeld
Robert
R
Cutler
Andrew J
AJ
Gazda
Thomas
T
Keck
Paul
P
Swann
Alan C
AC
Kalali
Amir H
AH
D000208:Acute Disease; D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D000077152:Olanzapine; D014635:Valproic Acid / Q000627:therapeutic use
D018692:Antimanic Agents; D003692:Delayed-Action Preparations; D018020:Lithium Compounds; D001569:Benzodiazepines; D002220:Carbamazepine; D014635:Valproic Acid; D000077152:Olanzapine