Background and Objectives: This review is dedicated to the use of
carbamazepine and its derivatives
oxcarbazepine and
eslicarbazepine in
bipolar disorder and their relative strengths in treating and preventing new depressive or
manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/
relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with
carbamazepine,
oxcarbazepine, and
eslicarbazepine in
bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute
mania than depression, which also translates to better protection against manic than depressive relapses for
carbamazepine. Still, there is a paucity of controlled acute studies on
bipolar depression for all and, with the exception of
carbamazepine, a lack of long-term monotherapy maintenance data. For
eslicarbazepine, the efficacy in
bipolar disorder remains largely unknown. Especially with
carbamazepine, tolerability issues and
drug-drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review,
carbamazepine and
oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.