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Tijdschrift voor Psychiatrie 45 (2003) 1, 35 - 43

Review article

Anticonvulsants in the treatment of aggression, anxiety, psychosis and alcohol and cocaine withdrawal symptoms

H.G.J. Barth-van Veldhuizen, C. Reinders, A.J.M. Loonen, W.A. Nolen

background  There is an increasing interest in the treatment of psychiatric symptoms with anticonvulsants, especially in the treatment of refractory patients. It is questionable whether or not the efficacy of anticonvulsants as psychotropic drugs is sufficiently verified.
aim  To examine the efficacy of anticonvulsants based on the available studies. Possible indications considered are aggression, anxiety, psychosis and alcohol and cocaine withdrawal symptoms.  method  Relevant literature is derived for the period between 1966 till now from Medline, Embase, the Cochrane Library and PsychINFO, using as key words anticonvulsants, anti-epileptics, carbamazepine, (sodium)valproate, valproic acid, divalproex, clonazepam, oxcarbazepine,
lamotrigine, vigabatrin, topiramate, gabapentin, phenytoin, diphenylhydantoin, mental disorders, epilepsy, affective disorders and trials.
resuls  Forty-six studies were included, which explored the efficacy of carbamazepine, clonazepam, phenytoin, gabapentin and valproic acid. The efficacy of carbamazepine in the treatment of aggression and of clonazepam in the treatment of the panic disorder are sufficiently verified. The additional value of carbamazepine and valproic acid for alcohol withdrawal is the increased rate of improvement. In the treatment of psychosis there is some evidence for the efficacy of anticonvulsants, especially as supplementary treatment.
conclusions  Carbamazepine is effective in the treatment of aggression and alcohol withdrawal. Clonazepam is effective in the treatment of the panic disorder. Concerning the other applications, there are indications for the efficacy of anticonvulsants. Additional research is needed to obtain more evidence for the support of these applications.

 

 

keywords aggression, anticonvulsants, anxiety, psychosis, withdrawal symptoms