A systematic review on the role of anticonvulsants in the treatment of acute bipolar depression

María Reinares, Adriane R. Rosa, Carolina Franco, José Manuel Goikolea, Kostas Fountoulakis, Melina Siamouli, Xenia Gonda, Sophia Frangou, Eduard Vieta

Research output: Contribution to journalReview article

28 Citations (Scopus)

Abstract

Despite the high morbidity and mortality associated with bipolar depression, the optimal treatment for this phase is still a matter of debate. The aim of the current review was to provide updated evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression. A comprehensive review of randomized controlled trials (RCTs) evaluating the use of anticonvulsants for the treatment of acute bipolar depression up to June 2011 was conducted by means of the PubMed-Medline database. Eligibility criteria included active comparator-controlled or placebo-controlled randomized studies involving monotherapy or combination therapy. A total of 18 RCTs fulfilled the inclusion criteria. Studies supported the efficacy of divalproex as monotherapy in acute bipolar depression but small sample size was a common methodological limitation. Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect. Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant. All anticonvulsants were generally well tolerated. No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine, licarbazepine, zonisamide, retigabine, pregabalin, tiagabine, felbamate and vigabatrine in the acute treatment of bipolar depression. To sum up, taking into consideration the efficacy and tolerability profiles of anticonvulsants, current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression. However, available data for most other anticonvulsants are inconclusive and further RCTs with larger sample sizes are needed before drawing firm conclusions.

Original languageEnglish
Pages (from-to)485-496
Number of pages12
JournalInternational Journal of Neuropsychopharmacology
Volume16
Issue number2
DOIs
Publication statusPublished - Mar 1 2013

Keywords

  • Anticonvulsants
  • antiepileptics
  • bipolar depression
  • clinical trials
  • randomized placebo-controlled

ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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    Reinares, M., Rosa, A. R., Franco, C., Goikolea, J. M., Fountoulakis, K., Siamouli, M., Gonda, X., Frangou, S., & Vieta, E. (2013). A systematic review on the role of anticonvulsants in the treatment of acute bipolar depression. International Journal of Neuropsychopharmacology, 16(2), 485-496. https://doi.org/10.1017/S1461145712000491