Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran

Naghmeh Mokhber¹, Carol J Lane², Mohamad R Azarpazhooh³, Elham Salari⁴, Reza Fayazi⁵, Mohamad T Shakeri⁶, Allan H Young⁷

¹Assistant Professor of Psychiatry, ³Assistant Professor of Neurology, ⁴Mashhad Department of Forensic Psychiatry, ⁵Assistant Professor of Psychiatry, ⁶Assistant Professor of Statistics, Mashhad University of Medical Science, Mashhad, Iran; ²Department of Psychiatry, University of British Columbia, Vancouver, Canada⁷

Abstract: The treatment of dysphoric mania is challenging given the need to treat symptoms of both depression and mania simultaneously without provoking any clinical exacerbation. The newer antiepileptic drugs such as gabapentin, lamotrogine, and carbamazepine are often used as adjuncts to either lithium or valproic acid in the treatment of bipolar disorder. We decided to undertake a monotherapy trial because previous evidence suggested mixed states may be more responsive to anticonvulsants than more traditional antimanic agents. 51 patients with a DSM IV diagnosis of dysphoric mania were randomized to three groups comprising gapbapentin, lamotrogine or carbamazepine and followed for 8 weeks. Psychiatric diagnosis was verified by the structural clinical interview for the DSM-IV (SCID). The MMPI-2 in full was used to assess symptoms at baseline and 8 weeks. All three groups showed significant changes in MMPI-2 scores for depression and mania subscales. Gabapentin showed the greatest change in depression symptom improvement relative to lamotrogine and carbamazepine, respectively. Although manic symptoms improved overall, there were no differences between groups in the degree of manic symptom improvement.

Keywords: dysphoric mania, manic-depression, depression, anticonvulsant, mood stabilizer