Novel anticonvulsants: a new generation of mood stabilizers?

The second-generation anticonvulsants carbamazepine and valproate are widely used as alternative mood stabilizers to lithium. Third-generation anticonvulsants are increasingly being used as mood stabilizers. Most of the current data are in the form of case reports, case series and open studies. Data from the two randomized controlled clinical trials suggest that lamotrigine may have efficacy in the treatment of bipolar depression and possible as maintenance agent. Gabapentin, tiagabine, and topiramate have been mostly evaluated as an add-on therapy in patients with bipolar disotders refractory to conventional mood stabilizers. The current results suggest that topiramate may be more effective in treating manic rather than depressive symptoms. Therefore, any conclusions of effectiveness requires confirmation in double-blind placebo-controlled trials