Open trial of carbamazepine in the prevention of recurrence of bipolar disorder in adolescents

While the existence of bipolar disorder in children and adolescents is now recognized, the prevalence of the disorder is still unknown, although it is clear that its' incidence increases markedly at puberty. The risks inherent in the course of the disorder, including recurrence and suicidal gestures, highlight the importance of its early recognition; however, diagnosis and identification of predictive factors in childhood bipolar disorder is problematic. Given the development of new mood-regulating psychopharmacological treatments for adults, early diagnosis in children is even more important. For children and adolescents, previous studies have shown the efficacy of lithium in the prevention of recurrence of bipolar disorder, but only over short periods of time. There are very few published studies on the use of carbamazepine in bipolar disorder; those that exist are most often single case studies. The authors present the results of an uncontrolled study of 11 patients, aged 10 to 17 years, diagnosed with bipolar according to DSM III-R criteria. These patients were treated with carbamazepine for a period of over 1 year. Two cases, especially noteworthy for their improvement, are presented in greater detail. A positive response was considered to have been obtained if a period greater than 1 year of normal affect was obtained. According to this criterion, seven patients were positive responders, two were moderate responders and two did not respond to treatment. Tolerance to the medication was good; in no cases it was necessary to interrupt treatment. Principle adverse side effects were biological, involving an increase in a single liver enzyme. Comparison among positive, moderate and non responders did not reveal any criteria predictive of therapeutic effectiveness. Despite methodological difficulties, these data point the importance of developing controlled studies with carbamazepine in the prevention of recurrence of bipolar disorder.