Oxcarbazepine add-on in the treatment of refractory bipolar disorder

Objective:  To assess the effectiveness and safety of oxcarbazepine (OXC) in bipolar disorder (BD) and related conditions.
Methods:  We reviewed medical records of patients given OXC treatment between March 2003 and March 2005 at the University of British Columbia Hospital. Response to treatment was assessed retrospectively using the Clinical Global Impression of Severity (CGI-S), and the Clinical Global Impression of Improvement (CGI-I) scales.
Results:  OXC was prescribed to 15 patients with bipolar I (n = 12), bipolar II (n = 2) and schizoaffective (n = 1) disorder who presented with depression (n = 9), mania (n = 3), hypomania (n = 1), or mixed state (n = 2). Six patients had Axis II diagnoses and 10 patients had a family history of mood disorders. Psychiatric co-morbidity was found in four patients. The mean daily dose of OXC was 775 ± 556.11 mg/day and the mean duration of follow-up was 31.60 ± 41.51 weeks. The OXC add-on led to a significant reduction in symptoms as indicated by reduction in CGI-S scores at 1 and 2 months. Nine of 12 patients at 1 month and seven of 14 at 1 or 2 months were much or very much improved on CGI-I scale. One patient (7%) developed hyponatremia. Six patients (40%) experienced no side effects and three patients (20%) stopped the medication because of side effects.
Conclusion:  OXC was effective and well-tolerated in refractory BD and schizoaffective disorder. These preliminary data are promising but controlled studies are needed to confirm its efficacy in refractory BD.     

Oxcarbazepine in the treatment of bipolar disorder: a review.

OBJECTIVE: To review the data on the efficacy of oxcarbazepine (OXC) in bipolar disorder (BD) and to provide recommendations for clinicians on the use of this medication in treating BD. METHOD: Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided search of MEDLINE for the years 1950 to 2005. RESULTS: Case reports, retrospective chart reviews, open prospective studies, and double-blind studies reported the efficacy and effectiveness of OXC in treating BD. The data indicate that OXC has efficacy in treating acute mania and may be a useful add-on in treating acute bipolar depression and in BD prophylaxis. OXC is generally well-tolerated. CONCLUSION: We recommend using OXC as monotherapy or as add-on therapy in refractory mania, but we recommend it be used predominantly as an add-on treatment for other phases of BD in patients who have not improved with well-established treatments or in patients who have difficulty tolerating adequate dosages.     

Evaluation of three simple methods for predicting therapeutic lithium doses

The bias and accuracy of three simple methods for predicting lithium doses were assessed in this prospective study. In each patient, we computed the predicted doses (PDs) of lithium by applying three formulas. The actual dose (AD), the lowest lithium dose that was enough to produce a serum lithium concentration higher than 0.80 mmol/l, was determined. The PD computed by each formula was then compared with the AD to identify the one with the least bias and the greatest accuracy in predicting therapeutic lithium doses. As mean prediction error (ME) is a convenient measure of bias, the prediction error (PE) of each comparison was computed by subtracting the AD from the PD. Accuracy was assessed as a function of the root-mean-squared prediction error (rMSE). Seventeen psychiatric inpatients participated in this study. The 95% confidence interval of ME of a proposed formula [Zetin, M., Garber, D., De Antonio, M., Schlegel, A., Feureisen, S., Fieve, R., Jewett, C., Reus, V., Huey, L.Y., 1986. Prediction of lithium dose: a mathematic alternative to the test-dose method. Journal of Clinical Psychiatry 47, 175-178] was across zero (-15.48 to 133.72). In addition, the rMSE of that formula was also the lowest one (152.66 mg/day). The method proposed by Zetin et al. (1986) is the least biased and the most accurate way to predict therapeutic lithium doses.     

Depot antipsychotic medications in bipolar disorder: a review of the literature

OBJECTIVE: To review the literature on the efficacy and safety of depot formulations of first- and second-generation antipsychotic medications (FGAs and SGAs) in patients with bipolar disorder. METHOD: We conducted a computer-aided MEDLINE search using the search terms 'depot antipsychotic', 'bipolar disorder' and 'compliance.' RESULTS: We identified eight published reports in bipolar patients regarding the use of depot FGAs, and six preliminary reports on the use of depot SGAs. These studies suggest that depots FGAs are efficacious in preventing manic episodes during the maintenance treatment of bipolar disorder. Several studies, however, indicate that depot FGAs may be associated with increased time with depressive symptoms, particularly in patients with a predominantly depressive course of illness. Preliminary data on the role of depot formulations of SGAs suggest that they reduce the frequency of both manic and depressive episodes during maintenance treatment, and are well tolerated by patients. CONCLUSION: After a careful risk-benefit analysis, depot antipsychotics may be considered for the long-term control of mood episodes in bipolar patients who have relapsed due to medication non-adherence or who have failed to respond to standard therapies. Depot FGAs should be avoided in patients with a high burden of illness from depressive symptoms and particularly in those judged to be at high risk of suicide. The available data on depot formulations of SGAs indicate that they are efficacious in the maintenance treatment of bipolar illness without increasing the burden of the depressive pole of the illness, but further systematic studies are required to definitively assess this.