Bipolar Disorder
Long-term Treatment of Bipolar Disorder with Carbamazepine Extended-Release Capsules in Adults, Adolescents, and Children
Lawrence D Ginsberg, MD
Red Oak Psychiatry Associates, Houston
Abstract
Bipolar disorder is a complex mental illness that usually requires long-term treatment, thus there is a need for a well-tolerated, efficacious maintenance therapy that can be used across a broad range of ages. A successful therapy should also increase patient adherence. Carbamazepine extended-release capsules have been shown to be safe and efficacious in patients with bipolar disorder. Importantly, this formulation was specifically developed to increase adherence. In this retrospective 25-month study, carbamazepine extended-release capsules were found to be efficacious for patients 4 to 69 years of age with a diagnosis of bipolar disorder I, II, or not otherwise specified (NOS). Side effects were generally mild to moderate and similar to those seen in other studies of carbamazepine in this patient population.
Keywords
Bipolar disorders, carbamazepine, anticonvulsants, long-term treatment
larrydg@earthlink.net
Bipolar disorder is a serious, lifelong illness that affects approximately 5.7 million American adults, or approximately 2.6% of the US population 18 years of age and over in a given year.1 25 years.2
It is a complex illness characterized by mania, depression, or mixed episodes, and rapid cycling.3
less successful in treating mixed mania and concurrent substance abuse, and is prone to causing weight gain.16–19
The median age of onset is Diagnosis and treatment are often
complicated by the presence of a variety of comorbid mental and medical disorders.4
The choice of treatment for bipolar disorder is dependent on a variety of factors, including presentation (mania or depression), the phase of the illness (acute or maintenance), specific features, history of response, treatment compliance, and the presence of comorbid conditions.5 Long-term pharmacotherapy is necessary for most patients; however, even with continuous maintenance therapy relapse is frequent (37% of patients relapse within one year and 73% relapse within five years).6
The US Food and Drug Administration has approved several agents for the treatment of bipolar disorder. These include mood stabilizers (e.g. lithium, valproate, lamotrigine,7 capsules [CBZ-ERC]8 ziprasidone,11
risperidone,12
) and the antipsychotics olanzapine,9 asenapine,13
extended formulations of quetiapine.15
and carbamazepine extended-release aripiprazole,10 and
and both the immediate14 All of these agents possess certain
benefits and drawbacks in terms of safety, tolerability, and efficacy. Lithium is associated with efficacy in bipolar I, although it appears to be
6
effective in treating acute mania and appears to be efficacious in rapid cycling;20
Valproate has also proved to be
Olanzapine has been shown to be effective in treating mania; however, it is associated with a high propensity for weight gain as well as strong associations with dyslipidemia, diabetes, and potentially life-threatening diabetic ketoacidosis.20,24–27
its disadvantages include a propensity for weight gain and hair loss, a sedating profile, and an association with polycystic ovarian syndrome.21–23
According to the 2002 American Psychiatric Association Guidelines for the treatment of bipolar disorder, lithium (either as monotherapy or in combination with an antipsychotic) is considered a first-line pharmacological intervention for treating acute bipolar mania and mixed episodes. Carbamazepine is suggested as an alternative to lithium.16
A
No single agent has been shown to be capable of preventing and/or controlling all of the facets of bipolar disorder; consequently, switching or combining therapies is often used to manage bipolar episodes.28,29 Approximately 68% of bipolar patients are taking more than one medication.30
Results of a six-month open-label study in bipolar patients treated with CBZ-ERC indicated a low (14.3%) relapse rate.33 retrospective chart review of bipolar patients treated with CBZ-ERC as
CBZ-ERC has been shown to be a safe and effective therapy for bipolar patients with acute manic and mixed episodes in three clinical trials.31–33
© TOUCH BRIEFINGS 2010
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