Carbamazepine and valproate in the maintenance treatment of bipolar disorder

Abstract

Background: Carbamazepine and valproate are used in the treatment of acute bipolar mania and as maintenance treatments for bipolar disorder. We reviewed the available data from randomized clinical trials of these agents in bipolar disorder to assess their efficacy and tolerability in the maintenance phase of illness management.

Data sources: We conducted a MEDLINE search augmented by a manual search of bibliographies, textbooks, and abstracts from recent scientific meetings to identify studies of carbamazepine and valproate in the maintenance treatment of bipolar disorder.

Data synthesis: Although a paucity of data exists from randomized, placebo-controlled trials, carbamazepine and valproate appear to prevent relapse as monotherapy in patients with bipolar disorder. Preliminary evidence of predictors of response to each respective agent has been identified. Combinations of carbamazepine and lithium and of valproate and olanzapine may have greater efficacy than monotherapy.

Conclusion: Although carbamazepine and valproate have been less well studied in maintenance treatment than lithium, each agent appears to have efficacy in this phase of illness management. However, for many patients, combination therapy may provide better long-term prevention of illness relapse and recurrence.