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. 2008 Feb;4(1):227-34.
doi: 10.2147/ndt.s2316.

Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran

Naghmeh Mokhber  1 , Carol J Lane, Mohamad R Azarpazhooh, Elham Salari, Reza Fayazi, Mohamad T Shakeri, Allan H Young
Affiliations

Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran

Naghmeh Mokhber et al. Neuropsychiatr Dis Treat. 2008 Feb.

Abstract

The treatment of dysphoric mania is challenging given the need to treat symptoms of both depression and mania simultaneously without provoking any clinical exacerbation. The newer antiepileptic drugs such as gabapentin, lamotrogine, and carbamazepine are often used as adjuncts to either lithium or valproic acid in the treatment of bipolar disorder. We decided to undertake a monotherapy trial because previous evidence suggested mixed states may be more responsive to anticonvulsants than more traditional antimanic agents. 51 patients with a DSM IV diagnosis of dysphoric mania were randomized to three groups comprising gapbapentin, lamotrogine or carbamazepine and followed for 8 weeks. Psychiatric diagnosis was verified by the structural clinical interview for the DSM-IV (SCID). The MMPI-2 in full was used to assess symptoms at baseline and 8 weeks. All three groups showed significant changes in MMPI-2 scores for depression and mania subscales. Gabapentin showed the greatest change in depression symptom improvement relative to lamotrogine and carbamazepine, respectively. Although manic symptoms improved overall, here were no differences between groups in the degree of manic symptom improvement.

Keywords: anticonvulsant; depression; dysphoric mania; manic-depression; mood stabilizer.

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Figures

Figure 1
Figure 1
Mean change of depression subscale of MMPI-2 test from the baseline to the endpoint in an 8-week, Randomized, Single-Blind Trial of Carbamazepine, Lamotrigine and Gabapentin for treatment of Dysphoric mania. Abbreviations: MMPI-2, Minnesota Multiphasic Personality Inventory-2; CBZ, carbamazepine; LTG, lamotrigine; GBP, gabapentin.
Figure 2
Figure 2
Mean change of mania subdimensions of hypomania subscale of MMPI-2 test from the baseline to the endpoint in an 8-week, Randomized, Single-Blind Trial of Carbamazepine, Lamotrigine and Gabapentin for treatment of Dysphoric mania. Abbreviations: MMPI-2,Minnesota Multiphasic Personality Inventory-2; CBZ, carbamazepine; LTG, lamotrigine; GBP, gabapentin.
Figure 3
Figure 3
Mean Percentage Improvement in the depression subdimensions of depression subscale in MMPI-2 test in an 8-week, Randomized, Single-Blind Trial of Carbamazepine, Lamotrigine and Gabapentin for treatment of Dysphoric mania. Abbreviations: MMPI-2, Minnesota Multiphasic Personality Inventory-2; CBZ, carbamazepine; LTG, lamotrigine; GBP, gabapentin; D1, Subjective Depression; D2, Psychomotor Retardation; D3, Body dysfunction; D4, Mental Dullness; D5, Brooding.
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