Gabapentin and lamotrigine in bipolar disorder

The utility of gabapentin and lamotrigine for the treatment of bipolar diso rder is reviewed. Bipolar disorder is characterized by extreme mood fluctuations, including m ania, hypomania, depression, and mixed episodes. Extrapolation of postulate d mechanisms of anticonvulsant activity in bipolar disorder has led to the use of the newer anticonvulsants gabapentin and lamotrigine for therapy. Bo th agents appear promising on the basis of limited (often anecdotal) eviden ce. They may prove effective in patients with difficult cases of bipolar di sorder, such as patients with rapid cycling, mixed episodes, and illness re fractory to other treatments. Lamotrigine may offer a much-needed treatment alternative for bipolar depression and could be found effective for acute mania, but the need for slow dosage adjustment and the risk of rash may lim it overall clinical utility..Gabapentin may offer significant advantages fo r acute mania: The dosage can be adjusted rapidly, adverse effects are gene rally minimal, the therapeutic index is high, there is no required laborato ry monitoring, and there is minimal potential for interactions with other p sychotropics. Until the results of randomized controlled trials are known, however, these two agents should be reserved for patients with bipolar diso rder unresponsive to traditional therapies and for patients who cannot tole rate traditional agents. Preliminary evidence indicates that gabapentin and lamotrigine may be usefu l, for the treatment of bipolar disorder.