update on the management of manic depressive illness

ABSTRACT

Nearly 1% of adults in the united states suffer from manic-depressive illness [or bipolar disorder], a severe, chronic, and life-threatening disease. This disorder is divided into three stages as follows acute mania, acute mania, acute depression, and maintenance. Lithium is the standard treatment for acute mania, and its effectiveness is solidly supported by experimental evidence. Over the past 40 years several studies including hundreds of patients have repeatedly shown the efficacy of lithium therapy, with approximately 80% of subjects responding favorably. However for those who do not respond, several other drugs have shown high success rates in well standardized trials. The anticonvulsant drug carbamazepine [CBZ] has been associated with improved symptoms in approximately 60 -70% of subjects in double-blind reials comparing it against placebo, neuroleptics, and/or lithium. Valproate [VPA] another another anticonvulsant drug has been shown to be comparable to lithium and superior to placebo in treating acute mania in several double-blind, placebo-controlled trials. In maintenance therapy clinical research has shown that lithium therapy lessens the frequency and severity of episodes of mania and depression in bipolar patients and helps stabilize mood between episodes. Furthermore, long-term lithium treatment reduces the risk of mortality of bipolar patients. Several other drugs have been studied as altematives or adjuncts to lithium therapy. Results from these studies have suggested that carbamazepine is similar in efficacy to lithium and significantly superior to placebo in the maintenance treatment of bipolar disorder. In addition, several open trials have reported moderate to good results with the combination of valproate and lithium or valproate alone. The purpose of this paper is to review the data supporting the use of CBZ and VPA for bipolar disorder, and where possible to compare them to lithium