Old and new antiepileptics in psychiatry

Abstract

Antiepileptics, in particular carbamazepine and valproate, have been used in the treatment of some psychiatric disorders characterised by affective and behavioural disturbances practically from their introduction into the clinics. However, in the last decade the appearance of a generation of safer and more easy-to-use anticonvulsants has prompted the widespread use of these agents by psychiatrists. New anticonvulsants are better tolerated and safer when compared with the classic ones and they have more convenient pharmacokinetics and less drug-drug interactions. While anticonvulsants have shown to be effective in a number of psychiatric disorders (notably in the treatment of affective bipolar disorder) as yet, their efficacy in many other conditions has not been well established by means of randomised clinical trials. In fact, the use of some anticonvulsants in many psychiatric entities is largely based on open or caseseries studies. Since the mechanisms of action of the different anticonvulsants are diverse, their efficacy in different psychiatric disorders is not a class effect. Therefore, further studies are needed to clearly define which agents and to which disorders they are more useful.