Carbamazepine vs Lithium in the Treatment and Prophylaxis of Mania

Abstract

Fifty-four acutely manic patients were allocated to treatment on a double-blind basis with either carbamazepine or lithium carbonate. The short-term effects of treatment were studied over a period of six weeks and the longer term, prophylactic, effects over a period of up to a year. Additional 'rescue' medication was allowed when clinically indicated. There was a high drop-out rate from the trial. Despite this, it appeared that valid comparisons between the two treatments could be made. No statistically significant differences were found, but carbamazepine appeared slightly less effective as a treatment for acute mania and more effective as a prophylactic treatment in this group of patients. Possible predictors of individual responsiveness to each treatment are discussed.

The Lithium Ion: A Foundation for Psychopharmacological Specificity

“…Several controlled studies corroborated carbamazepine's effectiveness in the acute treatment of mania and perhaps prophylaxis of the disorder (Okuma et al 1979(Okuma et al , 1990Coxhead et al 1992;Lusznat et al 1988;Small et al 1991;Watkins et al 1987). Most studies found it to be comparable to lithium in effectiveness, except for three studies (Okuma et al 1981;Lerer et al 1987;Watkins et al 1987).…”

A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder

“…36,39,40,42,43,[47][48][49][50][52][53][54][55][56][57]60,61,[64][65][66][67]69,72,74,77 Two of these studies compared only different doses of lithium and are not considered in the analyses. 52,61 Trial details are summarised in Table 2 and presented in the data extraction tables (Appendix 6).…”

“…47,53,57,60,72 All relapses Four trials provided data for all relapses and were included in both the base-case analysis and the best-case/worst-case sensitivity analysis. One trial 60 was excluded from the main analysis because participants were randomised while still in an acute phase of bipolar disorder.…”

“…When the trial 60 that randomised participants while they were in the acute phase of bipolar disorder was included in the analyses, the results were reversed to favour carbamazepine for relapse defined as admission to hospital (Table 17), but again, the pooled OR was not statistically significant.…”

“…47,53,57,60,72 Trial details are summarised in Table 41 and presented in the data extraction tables (Appendix 6).…”