26 Anticonvulsants Valproate Several galenic forms of valproic acid, the final active product, are available across the world, and have been used

since the 1960s in Europe for the treatment of bipolar disorder. Subsequently, two double-blind studies found valproate to be superior to placebo and as effective as lithium in the treatment of acute mania.22,27 A pooled analysis of these studies indicated that 54% of patients treated with valproate experienced a reduction of at least 50% in manic symptomatology LJnlike Inhibitors,research,lifescience,medical lithium, valproate has a rapid onset, of action, producing significant clinical improvements within 1 week, and is equally effective in treating mixed and classic mania.17 Valproate may not be as efficacious as antipsychotics such Inhibitors,research,lifescience,medical as olanzapine28,29 ), but is generally better tolerated.30 An extended-release form of valproate is also available and proven to be effective in mania.31 Some guidelines, such as the United Kingdom NICR guidelines, advise against the use of valproate in women of childbearing age, due to the high frequency of unplanned Inhibitors,research,lifescience,medical pregnancies in women with and even without bipolar disorder, and the relatively high selleck compound teratogenicity

of the compound, but this may be going too far, and could prove impractical.32 Other potential acute side effects of valproate arc weight, gain and hair loss. Carbamazepine Since its introduction into psychiatric treatment,33 carbamazepine has been evaluated in several randomized controlled trials, but most had methodological limitations such as small patient numbers or concomitant treatment. A placebo-controlled study in which patients were not receiving adjunctive medication found that 63% of carbamazepine-treated patients displayed significant improvements in manic, depressive, Inhibitors,research,lifescience,medical and psychotic symptoms, an effect, that was lost on switching to placebo.34 The statistical significance

of the treatment effect was not given, however. Recently, two randomized, double-blind studies have assessed an extended-release formulation Inhibitors,research,lifescience,medical of carbamazepine as monotherapy for the acute treatment of manic or mixed episodes.35,36 Both trials found carbamazepine to be significantly superior to placebo; side effects included dizziness, somnolence, nausea, vomiting, ataxia, blurred vision, dyspepsia, dry mouth, pruritus, and speech disorder. Two studies have compared carbamazepine with lithium Thiamine-diphosphate kinase in a randomized, controlled manner, with conflicting results. One found that lithium was superior,37 while the other found the drugs to be equivalent.38 Two studies comparing carbamazepine with chlorpromazine have found no differences between the drugs. A double -blind study found that carbamazepine in combination with lithium was as effective as lithium plus haloperidol in the treatment of acute mania.39 In all these studies, the antimanic effect of carbamazepine became evident after 1 to 2 weeks.