Psycho-Babble Medication | about biological treatments | Framed
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Re: lamotrigine dysphoria anyone?

Posted by kaleidoscope on May 27, 2007, at 13:13:28

In reply to Re: lamotrigine dysphoria anyone?, posted by kaleidoscope on May 27, 2007, at 12:50:28

It's interesting how a strange tendency has emerged among some US pdocs to prescribe the newer-generation anticonvulsants for bipolar disorder.

Depakote has good evidence of efficacy in the treatment of acute mania. Whether it's useful in the long term is less clear due to a surprising lack of high quality research. Lamictal has some value as a maintenance med. Tegretol may have some value in the treatment of mania, but it's certainly not first line.

Apart from Depakote, Lamictal and (to a lesser extent) Tegretol, none of the other antiepileptics have been shown to be useful in the treatment of bipolar disorder. I get the impression that they are being prescribed more frequently than they ought to be. Some pdocs seem to have abandonned evidence-based medicine completely. Lithium, Depakote and certain APs (such as olanzapine) have the best evidence of effectiveness in the treatment of mania. Prophylaxis is more difficult. Similarly, treatment of bipolar depression can be very difficult, there is no ideal treatment. If antidepressants (eg. an SSRI) are prescribed for a severe depressive episode, they should not generally be continued after the depression has resolved. Long-term use may be destabilising......and this may not be prevented by 'mood stabilisers'.




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