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 .
A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group.
BACKGROUND More treatment options for bipolar depression are needed . Currently available antidepressants may increase the risk of mania and rapid cycling , and mood stabilizers appear to be less effective in treating depression than mania . Preliminary data suggest that lamotrigine , an established antiepileptic drug , may be effective for both the depression and mania associated with bipolar disorder . This is the first controlled multicenter study evaluating lamotrigine monotherapy in the treatment of bipolar I depression . METHODS Out patients with bipolar I disorder experiencing a major depressive episode ( DSM-IV , N = 195 ) received lamotrigine ( 50  or  200 mg/day ) or placebo as monotherapy for 7 weeks . Psychiatric evaluations , including the Hamilton Rating Scale for Depression ( HAM-D ) , the Montgomery-Asberg Depression Rating Scale ( MADRS ) , Mania Rating Scale , and the Clinical Global Impressions scale for Severity ( CGI-S ) and Improvement ( CGI-I ) were completed at each weekly visit . RESULTS Lamotrigine 200 mg/day demonstrated significant antidepressant efficacy on the 17-item HAM-D , HAM-D Item 1 , MADRS , CGI-S , and CGI-I compared with placebo . Improvements were seen as early as week 3 . Lamotrigine 50 mg/day also demonstrated efficacy compared with placebo on several measures . The proportions of patients exhibiting a response on CGI-I were 51 % , 41 % , and 26 % for lamotrigine 200 mg/day , lamotrigine 50 mg/day , and placebo groups , respectively . Adverse events and other safety results were similar across treatment groups , except for a higher rate of headache in the lamotrigine groups . CONCLUSION Lamotrigine monotherapy is an effective and well-tolerated treatment for bipolar depression
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 .