The Texas Implementation of Medication Algorithms on the Use of Anticonvulsants in Bipolar I Disorder

Trisha Suppes, MD, PhD; Dorothy Kelly, MA


May 05, 2006

In This Article


It is only within the last 15 years that companies have begun to focus on the use of anticonvulsants in the treatment of bipolar disorder, and many new drugs have entered the market during that time. Although anticonvulsants have shown efficacy in the treatment of bipolar I disorder (BDI), only divalproex sodium and extended-release carbamazepine have received an indication for the treatment of acute mania, and to date, only lamotrigine has received an indication as a maintenance treatment of BDI. Despite this, many anticonvulsants are used "off-label" in the treatment of bipolar disorder, as helpful antimanic agents or adjunctive treatments. The Texas Implementation of Medication Algorithms (TIMA) includes anticonvulsants in its recommendations, as well as atypical antipsychotics, lithium, and other classes of medication.[1] For the purposes of this discussion, we will focus on evidence and recommendations for the use of anticonvulsants, although other options at each stage will also be mentioned.


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