Carbamazepine and lithium carbonate synergism in mania.

@article{Post1984CarbamazepineAL,
  title={Carbamazepine and lithium carbonate synergism in mania.},
  author={Robert M. Post and Thomas W Uhde},
  journal={Archives of general psychiatry},
  year={1984},
  volume={41 2},
  pages={
          210
        }
}
  • R. PostT. Uhde
  • Published 1 February 1984
  • Medicine, Psychology
  • Archives of general psychiatry
To the Editor.— Moss and James 1 presented an interesting case of an acute but unsustained antimanic response to the combination of carbamazepine and lithium carbonate. Several points raised in their letter deserve comment and further discussion. There are many potential reasons for the lack of a continued response to carbamazepine in combination with lithium carbonate in their case. One is dosage. The 800-mg/day dosage they employed was slightly below the average dosage in our series, with… 

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Carbamazepine and lithium carbonate synergism in mania.

A favorable but brief response to that combination of lithium carbonate and carbamazepine is reported in a patient who had not responded adequately to either drug alone.

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It appears that lithium exacerbates carbamazepine induced CNS side-effects or vice versa, the mechanism of which is not very clear, and simultaneous administration of these two drugs should preferably be avoided.

Use of the anticonvulsant carbamazepine in primary and secondary affective illness: clinical and theoretical implications

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Improvement was particularly notable in 2 patients with severe and fulminant rapidly cycling manic-depressive illness who had required essentially continuous state hospitalization for several decades prior to admission to NIMH, suggesting the potential usefulness of carbamazepine for treatment-resistant and rapidly cycling patients.

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A single daily dose of carbamazepine is insufficient; 2 doses per day are appropriate in most cases, but some patients may benefit from more frequent dosing to avoid side-effects.

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The possibility that the -10,11-epoxide metabolite of carbamazepine may be related to the degree of clinical efficacy in affectively ill patients and may thus possess active psychotropic properties in man in addition to its reported anticonvulsant effects in animals is suggested.

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A 22-year-old woman with bipolar affective disorder who developed severe neurotoxic symptoms when treated with a combined regimen of lithium carbonate and carbamazepine in therapeutic doses implicated a synergistic interaction between the two medications.