Switching from other agents to extended-release carbamazepine in acute mania.

Abstract

BACKGROUND:

There is a dearth of available knowledge relating to the efficacy of switching from one psychotropic agent to another in treating patients with acute mania.

METHODS:

This is a post hoc analysis of data from two randomized, placebo-controlled trials of carbamazepine extended-release capsules (CBZ-ERC) in the treatment of mania, to evaluate the efficacy of CBZ-ERC in patients previously nonresponsive to lithium (n 5 40), olanzapine (n 5 38), or valproate (VPA, n 5 77).

RESULTS:

In patients previously on lithium, Young Mania Rating Scale (YMRS) scores improved significantly from baseline to end point (27.4 6 SD 3.5 vs. 15.8 6 11.1; P 5 .0002). In patients previously on VPA or olanzapine, YMRS scores significantly improved in both CBZ-ERC- and placebo-treated groups (VPA: CBZ-ERC, P , .0001; placebo, P 5 .0002; olanzapine: CBZ-ERC, P , .0001; placebo, P 5 .0054). Improvement in YMRS was significantly greater in CBZ-ERC-treated patients versus placebo in subjects previously nonresponsive to lithium (CBZ-ERC 11.6 6 10.3 vs. placebo 4.0 6 11.2, P 5 .03), or VPA (CBZ-ERC 10.8 6 11.9 vs. placebo 5.7 6 9.2; P 5 .04), and trending to be greater for those previously nonresponsive to olanzapine (olanzapine 13.2 6 9.3 vs. placebo 7.3 6 9.7, P 5 .06).

CONCLUSIONS:

CBZ-ERC is an effective therapy for bipolar patients previously nonresponsive to lithium or valproate. Medication switch is frequently associated with symptom improvement.

• Authors: Rif S El-Mallakh, Terence A Ketter, Richard H Weisler, Robert Hirschfeld, Andrew J Cutler, Thomas Gazda, Paul Keck, Alan C Swann, Amir H Kalali
• Journal: Psychopharmacology bulletin (Psychopharmacol Bull) Vol. 41 Issue 1 Pg. 52-8 ( 2008) ISSN: 0048-5764 [Print] United States
• PMID: 18362871 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antimanic Agents
• Delayed-Action Preparations
• Lithium Compounds
• Benzodiazepines
• Carbamazepine
• Valproic Acid
• Olanzapine

Topics

• Acute Disease
• Adult
• Antimanic Agents (therapeutic use)
• Benzodiazepines (therapeutic use)
• Bipolar Disorder (drug therapy)
• Carbamazepine (administration & dosage)
• Delayed-Action Preparations
• Female
• Humans
• Lithium Compounds (therapeutic use)
• Male
• Olanzapine
• Valproic Acid (therapeutic use)