NEW DEVELOPMENTS IN THE USE OF ANTICONVULSANTS AS MOOD STABILIZERS

There is increasing recognition that lithium is inadequate in the trea tment of up to 50% of bipolar patients. In addition to subgroups that are nonresponsive from the outset, loss of efficacy (tolerance) and di scontinuation-induced refractoriness have recently been observed. The anticonvulsants carbamazepine and valproate are effective alternative or adjunctive treatments, but tolerance can also occur during their lo ng-term prophylactic use. New treatment algorithms for this loss ef ef ficacy, including combination therapies, require further systematic st udy. Preliminary data suggesting that some patients with extremely rap id and chaotic mood fluctuations may respond to the L-type calcium cha nnel blocker nimodipine are presented, and the theoretical implication s discussed.