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 .
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 up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression .
Randomized, double-blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression.
BACKGROUND Uncertainty exists regarding the best approach for treating bipolar depression among patients already receiving a first-line mood stabilizer . The aim of this pilot study was to compare adding a second mood stabilizer or an antidepressant at this treatment decision point . METHODS Twelve-week , r and omized , double-blind pilot trial comparing the addition of lamotrigine or citalopram for bipolar depressed patients on mood stabilizer medication . Change in depressive symptoms and risk of switch were examined . RESULTS Twenty subjects were r and omized . Each treatment group experienced a significant mean reduction in total MADRS scores  ( citalopram Delta - 14.2 , p=0.002 ; lamotrigine Delta - 13.3 , p= 0.001 ) , and there was no significant difference between treatment groups ( p=0.78 ) . Total response rates increased from 31.6 % at week 6 to 52.6 % at week 12 . One out of ten patients in each group experienced a switch to hypomania . LIMITATIONS Small sample size . Lack of a placebo arm . CONCLUSIONS Results of this small trial suggest that both lamotrigine and citalopram appear to be reasonable choices as add-on acute treatment for bipolar depression , with response rates continuing to rise considerably past 6 weeks of treatment
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 .
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 up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression .