Anticonvulsants as mood stabilisers

Recent research has highlighted the fact that a significant number of patients with bipolar affective disorder have a poor outcome (Cole et al, 1993). The most common poor outcome is the development of rapid or ultra-rapid cycling, but mixed states, prolonged depression and severe mania are also associated with poor outcome. It is estimated that approximately one-third of patients with bipolar affective disorder do not respond fully to lithium and a significant number of patients discontinue lithium (Post, 1990) which may itself cause further problems. The discovery that anticonvulsants have a therapeutic potential in mood disorders was largely serendipitous. It was noticed that these agents improved mood in some patients with epilepsy and there were reports that, in patients with epilepsy and refractory bipolar disorder, the drugs sometimes alleviated and subsequently stabilised mood distur bances (Sussman, 1997). This led to research into the use of anticonvulsants as alternatives or supplements to lithium in the treatment of bipolar affective disorder, particularly when outcome is poor.