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 .
Acute efficacy of divalproex sodium versus placebo in mood stabilizer-naive bipolar I or II depression: a double-blind, randomized, placebo-controlled trial.
OBJECTIVE To conduct an exploratory evaluation of the acute efficacy of extended-release divalproex sodium compared to placebo in patients with bipolar I or II depression . METHOD Out patients aged 18 - 70 years with mood stabilizer-naive bipolar I or II disorder experiencing a major depressive episode ( DSM-IV ) were r and omly assigned to 6 weeks of divalproex sodium monotherapy or placebo . The primary outcome measure was mean change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) total score . Secondary outcomes included rates of response and remission , changes in the Clinical Global Impressions-Bipolar ( CGI-BP ) Severity of Illness scores , and changes in anxiety symptoms as measured by the Hamilton Anxiety Rating Scale . The study was conducted between 2003 and 2007 . RESULTS Fifty-four subjects with bipolar I ( n = 20 ) or bipolar II ( n = 34 ) disorder were r and omly assigned to divalproex or placebo ; 67 % ( 36 of 54 ) met DSM-IV criteria for rapid cycling . Divalproex treatment produced statistically significant improvement in MADRS scores compared with placebo from week 3 onward . The proportions of patients meeting response criteria were 38.5 % ( 10 of 26 ) in the divalproex group versus 10.7 % ( 3 of 28 ) for the placebo group ( P = .017 ) . The proportions of patients meeting remission criteria were 23.1 % ( 6 of 26 ) for divalproex versus 10.7 % ( 3 of 28 ) for placebo ( P = .208 ) . Subgroup analysis revealed no separation between divalproex and placebo for those with bipolar II diagnoses . Nausea , increased appetite , diarrhea , dry mouth , and cramps were the most common side effects . CONCLUSIONS These data suggest that divalproex sodium is efficacious and reasonably well tolerated in the acute treatment of mood stabilizer-naive patients with bipolar depression , particularly for those with rapid-cycling type I presentations , and that confirmatory large-scale studies are indicated . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT00194116
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 .