Comparison of Two Anticonvulsants in a Randomized, Single-Blind Treatment of Hypomanic Symptoms in Patients with Bipolar Disorder

University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9121, USA.
Australian and New Zealand Journal of Psychiatry (Impact Factor: 3.41). 06/2007; 41(5):397-402. DOI: 10.1080/00048670701261186
Source: PubMed


Oxcarbazepine was compared to divalproex to assess clinical effectiveness of a proven agent, divalproex, against a newer, less studied agent, oxcarbazepine, in the treatment of hypomania.
Thirty patients with bipolar disorder, currently hypomanic, were randomized to receive oxcarbazepine or divalproex as add-on or monotherapy for 8 weeks. A rater blind to treatment assignment performed all symptom ratings. Hypomania and depression were rated using the Young Mania Rating Scale (YMRS) and the Inventory of Depressive Symptoms-Clinician Version (IDS-C). Random regression models were used to assess clinical symptom scores.
There were no significant differences of YMRS or IDS-C scores between groups. Mean YMRS scores at baseline were 22.07+/-5.86 and 20.53+/-6.02 for the oxcarbazepine and the divalproex groups, respectively. Mean percent reduction from baseline to week 8 for the YMRS was 63.8% and 79.0% for oxcarbazepine and divalproex groups, respectively. Mean percent reduction from baseline to week 8 for the IDS-C was 48.7% versus 19.7% for oxcarbazepine and divalproex groups, respectively. Significant antimanic efficacy was noted for each medication. Both medications were generally well tolerated.
In this pilot study, oxcarbazepine was as effective as divalproex in the treatment of hypomania. Further controlled trials are warranted.

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    • "Our case suggests that OXC might have considerable dopamine-mediated effects in certain humans, which has to be considered during its prescription in both epilepsy and psychiatric disorders. The dopaminergic effect of OXC and its active metabolite might presumably play also an ambivalent, but important role in the treatment of alcohol addiction [8] and bipolar disorder [5] [9]; therefore, further studies are required to investigate its psychopharmacological aspects. "
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    ABSTRACT: Although there is a relatively high prevalence of both idiopathic Parkinson's disease (PD) and epilepsy in the elderly population, and PD occurs more frequently in people with epilepsy, there are no studies investigating the efficacy and tolerability of antiepileptic drugs (AEDs) in people with PD. We describe the case of a 71-year-old man with PD who experienced several seizures. The initiation of antiepileptic treatment with oxcarbazepine (OXC) provoked a severe, long-lasting psychotic state. The patient had previously experienced similar psychotic episodes during dopamine agonist therapy. Because recent animal studies have proven that OXC and its active metabolite exert important dopamine- and serotonin-promoting effects in the limbic area, we assumed that in our case the OXC-induced psychosis was mediated by the dopaminergic system. We concluded that OXC should be used with care in cases of a constellation of PD and epilepsy because of its possible psychiatric side effects. The dopaminergic effect of OXC and its active metabolite might also play an ambivalent, but important role in the treatment of alcohol addiction and bipolar disorder; therefore, further studies are required to investigate its psychopharmacological aspects.
    Full-text · Article · May 2008 · Epilepsy & Behavior
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    • "In a more recent study applying an on-off-on design, however, oxcarbazepine appeared inefficacious in severely manic patients, but only in mildly to moderately manic patients.173 This is in line with a recent randomized, single-blind trial showing similar efficacy of oxcarbazepine and valproate in hypomania.174 In addition, a randomized, controlled study in adolescent mania failed to separate oxcarbazepine from placebo;175 thus, the case for oxcarbazepine in acute mania is rather weak. "
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    • "The clinical efficacy of OXC, the 10-keto analogue of CBZ, in the treatment of acute mania and hypomania is reasonably well documented in adults, but not in children and adolescents [12-14], although there are as yet no large randomized clinical trials attesting to its efficacy as a mood-stabilizer [15,16]. However, extant studies suggest that OXC could be effective as monotherapy or as adjunctive therapy in almost 60% of patients with BPD [17-19]. "
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