background Lithium is first choice in the prevention of prospective episodes in patients with bipolar disorder, although efficacy in clinical practice may be less impressive than anticipated from clinical trials. Alternative treatments, including carbamazepine, are increasingly being advocated for that reason. Furthermore, equipotency of carbamazepine and lithium is still questionable.
aim To examine the prophylactic efficacy of carbamazepine in treatment-naive bipolar patients. To examine whether the view that carbamazepine is equivalent to lithium as first step in the prophylactic treatment of bipolar patients.
method Using six qualitycriteria, we reviewed one open trial and six double-blind trials on the use of carbamazepine in the prophylaxis of bipolar affective disorder.
results None of the studies met all criteria. In particular, the statistical power of most studies is low. An estimation of prophylactic efficacy of carbamazepine is precluded because of inclusion of nonresponders to lithium and inclusion of patients with other than bipolar diagnoses. The view that carbamazepine is equivalent to lithium as first step in the prophylactic treatment of bipolar patients, is insufficiently supported by the literature reviewed.
conclusions Carbamazepine cannot be considered as an equivalent to lithium for patients who receive prophylactic treatment for the first time. Carbamazepine should be reserved for patients with insufficient response to lithium or patients who cannot be treated with lithium for other reasons.