Beyond lithium in the treatment of bipolar illness.
Post RM , Frye MA , Denicoff KD , Leverich GS , Kimbrell TA , Dunn RT
Biological Psychiatry Branch, National Institute of Mental Health,
Bethesda, Maryland 20892-1272, USA.
Neuropsychopharmacology 1998 Sep;19(3):206-19
Dramatic changes have recently occurred in the availability of treatment
options for bipolar illness. Second generation mood stabilizing
anticonvulsants carbamazepine and valproate are now widely used as
alternatives or adjuncts to lithium. High potency benzodiazepines are also
used as alternatives to typical neuroleptics, and now atypical neuroleptics
are demonstrating efficacy and better side-effects profiles than the
typicals. Thyroid augmentation strategies and dihydropyridine L-type
calcium channel blockers require further clinical trials to define their
role. Putative third generation mood stabilizing anticonvulsants
lamotrigine, gabapentin, and topiramate have
unique mechanisms of action and deserve further systematic study, as does
the potential role for nonconvulsive brain stimulation with repeated
magnetic stimulation (rTMS). These and a host of other potential
treatment options now require a new generation of clinical trials to help
identify clinical and biological markers of response and optimal use alone
and in complex combination therapeutic regimens.
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