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, here were no differences between groups in the degree of manic symptom improvement.