Antiepileptic drugs for the acute and maintenance treatment of bipolar disorder

Both traditional and newer antiepileptic drugs have been considered for the acute and maintenance treatment of bipolar disorder. Although the psychotropic actions of these compounds have long been recognized, their specific mood-stabilizing properties have become evident only relatively recently. Carbamazepine and valproate are the antiepileptics most thoroughly studied for the treatment of bipolar disorder, but trials of the newer compounds such as lamotrigine, gabapentin, topiramate, and tiagabine have also begun to emerge. This article reviews the published research (including controlled trials, outcome reports, case series, and anecdotal observations) relevant to the efficacy of these agents in the acute and maintenance treatment of bipolar disorder. It also reviews the available information regarding clinical predictors of response. Despite considerable interest in these drugs, data are still limited. Comparison of clinical responses to the various mood stabilizers and determination of their mechanisms of action could help to improve treatment for bipolar disorder.