Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: principles and practice.
ABSTRACT Carbamazepine began to be studied in a systematic fashion in the 1970s and became more widely used in the treatment of bipolar disorder in the 1980s. Interest in carbamazepine has been renewed by (i) the recent US FDA approval of a long-acting preparation for the treatment of acute mania; (ii) studies suggesting some efficacy in bipolar depression; and (iii) evidence of prophylactic efficacy in some difficult-to-treat subtypes of bipolar illness. A series of double-blind controlled studies of the drug were conducted at the US National Institute of Mental Health from the mid-1970s to the mid-1990s. This review summarises our experience in the context of the current literature on the clinical efficacy, adverse effects and pharmacokinetic interactions of carbamazepine. Carbamazepine has an important and still evolving place in the treatment of acute mania and long-term prophylaxis. It may be useful in individuals with symptoms that are not responsive to other treatments and in some subtypes of bipolar disorder that are not typically responsive to a more traditional agent such as lithium. These subtypes might include those patients with bipolar II disorder, dysphoric mania, substance abuse co-morbidity, mood incongruent delusions, and a negative family history of bipolar illness in first-degree relatives. In addition, carbamazepine may be useful in patients who do not adequately tolerate other interventions as a result of adverse effects, such as weight gain, tremor, diabetes insipidus or polycystic ovarian syndrome. We review our clinical and research experience with carbamazepine alone and in combination with lithium, valproic acid and other agents in complex combination treatment of bipolar illness. More precise clinical and biological predictors and correlates of individual clinical responsiveness to carbamazepine and other mood stabilisers are eagerly awaited.
- SourceAvailable from: Bettahalasoor SomashekarMental Illnesses - Evaluation, Treatments and Implications, 01/2012; , ISBN: 978-953-307-645-4
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ABSTRACT: The clinical interface between psychiatry and neurology is epilepsy; the pharmacological expression of this interface is antiepileptic drugs (AEDs), as they are used to treat both epilepsy and psychiatric disorders, especially bipolar disorders. The prevalence of psychiatric comorbidity and the risk of suicidal behavior/ideation/suicide are markedly increased in patients with epilepsy (PWE). Though AEDs receive initial indications for the treatment of epilepsy, currently the majority of AEDs are used to treat pain and psychiatric disorders. Thus in selecting the appropriate AEDs for treatment of PWE, consideration should be given to which AEDs best treat the epileptic disorder and the psychiatric comorbidity. This review is an overview of 21 AEDs in which negative psychotropic properties, approved indications in psychiatry, off-label studied uses in psychiatry, and principal uses in psychiatry are presented with literature review. A total of 40 psychiatric uses have been identified. Of the 21 AEDs reviewed, only 5 have U.S. Food and Drug Administration and/or European Medicines Agency psychiatric approval for limited uses; the majority of AEDs are used off-label. Many of these off-label uses are based on case reports, open-label studies, and poorly controlled or small-sample-size studies. In some instances, off-label use persists in the face of negative pivotal trials. Further placebo-controlled (augmentation and monotherapy) parallel-arm research with active comparators is required in the complex field of AED treatment of psychiatric disorders to minimize the treatment gap not only for PWE with psychiatric disorders, but also for psychiatric patients who would benefit from properly studied AEDs while minimizing adverse effects.Epilepsy & Behavior 05/2011; 21(1):1-11. DOI:10.1016/j.yebeh.2011.03.011 · 2.06 Impact Factor
Conference Paper: Evaluating cost-performance tradeoffs for system level applications[Show abstract] [Hide abstract]
ABSTRACT: Evaluation of design cost and performance is indispensable to system partitioning. In the absence of a system-level estimation and analysis tool, system partitioning is difficult to perform in an efficient and accurate manner because design evaluation can only be done after the final results are achieved. Furthermore, without cost-performance tradeoff information relating to different design alternatives, the designer can not make intelligent design decisions at the early system-level partitioning stages. In this paper, we present a system-level cost/performance evaluation approach which systematically explores the AT (Area-Time) design-space from a system description. This allows the designer to obtain first-hand design tradeoff information before the partitioning process has taken place. We have also developed a system-level interactive design evaluation system on top of the proposed approach. Experiments on a number of examples demonstrate that our approach provides the designer with a comprehensive system-level design evaluation method to effectively explore all possible design, alternatives in the early stages of system developmentDesign Automation Conference 1997. Proceedings of the ASP-DAC '97. Asia and South Pacific; 02/1997