The purpose of this study was to investigate the effectiveness of zonisamide in the treatment of bipolar depression.
Ten patients with DSM-IV bipolar disorder, depressed phase, who had either not tolerated or not responded to previous treatments were given zonisamide in this add-on open-label study. Zonisamide treatment was started at 100 mg/day and increased by 100 mg every 2 weeks to a maximum of 300 mg/day in divided doses (b.i.d. or t.i.d.). Subjects underwent weekly visits at which they were administered the 17-item Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Clinical Global Impressions scale (CGI). Every 2 weeks, subjects also underwent laboratory tests, a urine examination, and a verbal memory test. Outcome measures were analyzed with repeated-measures analysis of variance.
Eight subjects completed all 8 weeks of the study. Two subjects completed more than 4 weeks of the study, and their data were analyzed using the last observation carried forward. Bipolar depression subjects had a significant reduction in HAM-D scores (p < .001) and in CGI-Improvement (CGI-I) scores (p < .001). Five of 8 subjects who completed all 8 weeks of the study had more than a 50% decrease in HAM-D scores and were rated much improved on the CGI-I at the end of 8 weeks of treatment. There was no significant drug effect on YMRS scores, weight, or verbal memory.
Zonisamide may be a useful drug in the treatment of bipolar depression. Further controlled clinical trials are needed.
"In an open-label study of bipolar and schizoaffective manic adults, 71% showed significant global improvement on zonisamide . Another preliminary study of zonisamide in 10 patients with bipolar depression found significant clinical global improvement scores and reduction in depressive symptoms . However, there was no significant effect of the drug on improving mania scores in these patients. "
[Show abstract][Hide abstract] ABSTRACT: Aggressive symptomatology presents across multiple psychiatric, developmental, neurological and behavioral disorders, complicating the diagnosis and treatment of the underlying pathology. Anti-Epileptic Drugs (AEDs) have become an appealing alternative in the treatment of aggression, mood lability and impulsivity in adult and pediatric populations, although few controlled trials have explored their efficacy in treating pediatric populations. This review of the literature synthesizes the available data on ten AEDs – valproate, carbamazepine, oxcarbazepine, phenytoin, lamotrigine, topiramate, levetiracetam, zonisamide, gabapentin and tiagabine – in an attempt to assess evidence for the efficacy of AEDs in the treatment of aggression in pediatric populations. Our review revealed modest evidence that some of the AEDs produced improvement in pediatric aggression, but controlled trials in pediatric bipolar disorder have not been promising. Valproate is the best supported AED for aggression and should be considered as a first line of treatment. When monotherapy is insufficient, combining an AED with either lithium or an atypical anti-psychotic can result in better efficacy. Additionally, our review indicates that medications with predominately GABA-ergic mechanisms of action are not effective in treating aggression, and medications which decrease glutaminergic transmission tended to have more cognitive adverse effects. Agents with multiple mechanisms of action may be more effective.
"Oxcarbazepine may also exhibit both interactions with other medications and tolerability issues, but to a lesser degree than carbamazepine; however, the risk of hyponatremia appears to be greater with oxcarbazepine. Other anticonvulsants with CE of efficacy ''C1'' 4 include levetiracetam (Goldberg and Burdick 2002; Grunze et al. 2003b; Kyomen 2006; Desarkar et al. 2007) and zonisamide (Kanba et al. 1994; McElroy et al. 2005; Anand et al. 2005). One small case series (Amann et al. 2006) gives retigabine ''C1'' evidence. "
[Show abstract][Hide abstract] ABSTRACT: These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A-F). As these guidelines are intended for clinical use, the scientific evidence was finally asigned different grades of recommendation to ensure practicability.
The World Journal of Biological Psychiatry 05/2009; 10(2):85-116. DOI:10.1080/15622970902823202 · 4.18 Impact Factor
"184-189 Topiramate first appeared to be a promising treatment option in pilot studies; however, five double-blind, randomized studies could not prove efficacy in acute mania.190,191 Nevertheless, due to their weight-reducing effect, topiramate as well as zonisamide, which showed distinct antimanic and antidepressant properties in open trials,192-196 may still be options as an add-on treatment in patients who massively gain weight with established mood stabilizers. "
[Show abstract][Hide abstract] ABSTRACT: Anticonvulsant drugs are widely used in psychiatric indications. These include mainly alcohol and benzodiazepine withdrawal syndromes, panic and anxiety disorders, dementia, schizophrenia, affective disorders, bipolar affective disorders in particular, and, to some extent, personality disorders. A further area in which neurology and psychiatry overlap is pain conditions, in which some anticonvulsants, and also typical psychiatric medications such as antidepressants, are helpful. From the beginning of their psychiatric use, anticonvulsants have also been used to ameliorate specific symptoms of psychiatric disorders independently of their causality and underlying illness, eg, aggression, and, more recently, cognitive impairment, as seen in affective disorders and schizophrenia. With new anticonvulsants currently under development, it is likely that their use in psychiatry will further increase, and that psychiatrists need to learn about their differential efficacy and safety profiles to the same extent as do neurologists.
Dialogues in clinical neuroscience 02/2008; 10(1):77-89.
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