Carbamazepine, a possible adjunct or alternative to lithium in bipolar disorder.

The effect of carbamazepine in bipolar disorder has been studied by several groups. According to these studies carbamazepine appears to exert a "lithium-like" effect. Twelve patients with lithium-resistant bipolar disorder and without epilepsy were prophylactically treated for 3 years with carbamazepine in an open study. In most patients carbamazepine was added to lithium, neuroleptics and/or antidepressants. Four patients did not complete the minimum treatment period of 6 months required for evaluation. In the remaining eight patients carbamazepine seemed to be effective in four patients, had a possible or slight effect in two, and no effect in the remaining two. It is concluded that carbamazepine can be safely combined with lithium, and that carbamazepine, eventually combined with lithium, can be effective in lithium(-alone)-resistant bipolar disorder.