Posted by cache-monkey on June 9, 2005, at 20:46:56
The study is obviously not without it's limitations (small sample size, naturalistic cross-sectional design), but the butshell seems to be (in order from best to worst):
Lamictal > Trileptal > Lithium > Topomax > Depakote > Tegetrol(?)From: https://www.cnsvs.com/index.php?option=content&task=view&id=43&Itemid=60
COMPARATIVE NEUROCOGNITIVE EFFECTS OF FIVE PSYCHOTROPIC ANTICONVULSANTS AND LITHIUM
C Thomas Gualtieri MD Lynda G Johnson, PhD
MS Submitted for publication, December, 2004
ABSTRACT
CONTEXT: Many of the new antiepileptic drugs have psychiatric indications, and most are prescribed by psychiatrists for patients with mood disorders, even absent a specific indication. Epileptic drugs in general, even the newer ones, are known to effect cognition, sometimes in untoward ways. Research on the neurocognitive effects of anti-epileptic drugs, however, has been done exclusively in normal volunteers and in patients with seizure disorders.METHOD: A naturalistic, cross-sectional study of patients on one of 5 different psychotropic anticonvulsants or lithium. Cognition measured by a computerized neurocognitive screening battery, CNS Vital Signs. SUBJECTS: 159 patients with bipolar disorder, age 18-70, treated with carbamazepine (N=16), lamotrigine (38), oxcarbazepine (19), topiramate (19) and valproic acid (37); 30 bipolar patients on lithium, for purposes of comparison.
RESULTS: Significant group differences were detected in tests of memory, psychomotor speed, processing speed, reaction time, cognitive flexibility and attention. Rank order analysis indicated superiority for lamotrigine (1.8) followed by oxcarbazepine (2.1), lithium (3.3), topiramate (4.3), valproic acid (4.5) and carbalzepine (5.0).
CONCLUSIONS: The relative neurocognitive effects of the various psychotropic antiepileptic drugs in patients with bipolar disorder are concordant with those described in the seminal literature in normal volunteers and patients with epilepsy. Lamotrigine and oxcarbamazepine have the least neurotoxicity, and topiramate, valproate and carbamazepine have the most. Lithium effects on neurocognition are intermediate. Choosing a mood- stabilizing drug with minimal neurocognitive effects may enhance patient compliance over the long-term.
poster:cache-monkey
thread:510238
URL: http://www.dr-bob.org/babble/20050606/msgs/510238.html