Comparative Prophylactic Efficacy of Lithium, Carbamazepine, and the Combination in Bipolar Disorder

• DOI: 10.4088/jcp.v58n1102
• Publication Date: 2010-11-12T20:11:19Z
• Authors: Kirk D. Denicoff; Earlian E. Smith-...; Elizabeth R. Disney; S. Omar Ali; Gabriele S. Leverich; Robert M. Post
• Keywords: Crossover study; Depression

Article AbstractBackground: We compared the prophylactic efficacy of lithium, carbamazepine, and combination identified possible clinical markers response. Method: Fifty-two outpatients who met DSM-III-R criteria for bipolar illness were randomly assigned in a double-blind design an intended 1 year treatment with lithium or crossover to opposite drug second year, then third on combination. Patients received monthly detailed evaluations, daily life chart ratings degree functional incapacity associated mania depression completed. Results: For evaluable patients: 13 (31.0%) 42 failed complete full therapy owing lack efficacy, 2 dropped out because side effects; (37.1%) 35 withdrew from carbamazepine within first 10 effects (9 had rash); 7 (24.1%) 29 efficacy. The percentage patients marked moderate improvement Clinical Global Impressions scale was 33.3% 31.4% 55.2% treatment, which not significantly different. By variety measures, more effective than prophylaxis mania. past history rapid cycling did poorly monotherapy (28.0% responded lithium; 19.0% carbamazepine), but better (56.3%, p < .05). Conclusion: These prospective, randomized data suggest high incidence inadequate response either mood stabilizer their despite use adjunctive agents as needed. Additional novel regimens are needed decrease affective morbidity large numbers outpatients.