Bipolar disorder gabapentin

Anticonvulsants. Finally, several antiseizure medications have been tried. These include valproic acid (Depakote, Depakene), carbamazepine (Tegretol), Lamotrig-ine (Lamictal), and gabapentin (Neurontin). The anticonvulsants are effective treatments for bipolar disorder. Their use for major depression needs to be studied further. Please refer to Section 3.4 Bipolar Disorders. 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

Virtually all anticonvulsants are or have been of interest for the treatment of bipolar disorder. However, the importance of controlled data cannot be understated. For example, gabapentin, an anticonvulsant that initially received much attention as a potential mood stabilizer, was compared with placebo and did not appear to stabilize mood (Frye et al. 2000 Pande et al. 2000). Similar negative results were seen with topiramate in placebo-controlled trials for the treatment of mania. Although these medications might be useful adjuncts in some patients, given the currently expanded pharmacopoeia of medications with positive controlled trial data in bipolar disorder, we do not recommend the primary use of agents that have only case reports as an evidence base or controlled studies with predominantly negative results. 

Other agents with anticonvulsant properties that may be of use m the treatment of bipolar disorder include topiramate, gabapentin, tiagabine and carbamazepine (Janicak et al., 2001). 

McElroy SL, Soutullo CA, Keck PE Jr, et al. A pilot trial of adjunctive gabapentin in the treatment of bipolar disorder. Ann Clin Psychiatry 1997 9 99-103. 

Another group of mood-stabilizing drugs that are also anticonvulsant agents have become more widely used than lithium. These include carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence. Lamotrigine is approved for prevention of recurrence. Gabapentin, oxcarbazepine, and topiramate are sometimes used to treat bipolar disorder but are not approved by FDA for this indication. Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone are approved by FDA for the treatment of manic phase of bipolar disorder. Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression. 

Montes JM, Ferrando L. Gabapentin-induced anorgasmia as a cause of noncompliance in a bipolar patient. Bipolar Disord 2001 3(1) 52. 

Catatonia was reported in a 48-year-old woman with bipolar disorder within 48 hours of withdrawal of gabapentin, 500 mg/day. The condition lasted for several days and disappeared after treatment with a benzodiazepine. 

Gabapentin has been associated with hostility, especially in children. Two cases of aggression in adults taking gabapentin for bipolar disorder have been reported (285). Neither patient had a history of aggression. In one the symptoms appeared after 3 days of treatment (1200 mg/ day), and in the other after 48 hours (600 mg/day). In the second case, aggression was associated with auditory hallucinations. It is hard to associate new antiepileptic drugs... 

Gabapentin is itself an augmenting agent to numerous other anticonvulsants in treating epilepsy and to lithium, atypical antipsychotics and other anticonvulsants in the treatment of bipolar disorder... 

Atypical antipsychotics may be preferable to gabapentin if treatment of bipolar disorder is required during pregnancy... 

Atypical antipsychotics and anticonvulsants such as valproate may be safer and more effective than gabapentin during the postpartum period when treating a nursing mother with bipolar disorder... 

Misperceptions about gabapentin s efficacy in bipolar disorder have led to its use in more patients than other agents with proven efficacy, such as lamotrigine Off-label use as an adjunct for schizophrenia may not be justified May be useful for some patients in alcohol withdrawal... 

The effectiveness of gabapentin has been studied in 22 patients with bipolar disorder who had an incomplete response to other mood stabilizers (5). Somnolence was common (six patients) adverse events that occurred in two patients each included irritability, memory impairment, headache, and tremor. One patient dropped out because of a mild rash. 

A 27-year-old man with bipolar disorder had an increased serum creatinine concentration (np to 1.7 mg/dl, 150 pmol/l) after taking gabapentin 2000 mg/day for several weeks, the change being reversible after drug withdrawal (31). 

Vieta E, Martinez-Aran A, Nieto E, Colom F, Reinares M, Benabarre A, Gasto C. Adjunctive gabapentin treatment of bipolar disorder. Eur Psychiatry 2000 15(7) 433-7. 

Brauuou GE, RoUaud PD. Auorgasmia iu a patient with bipolar disorder type 1 treated with gabapentin. J Clin Psychopharmacol 2000 20(3) 379-81. 

The place in therapy of the newer anticonvulsants, such as gabapentin, levetiracetam, tiagabine, topiramate, and zon-isamide, is controversial. Many clinicians consider these agents to be less effective than established mood stabilizers based on initial studies and avoid them for monotherapy in bipolar disorder. 

The use of gabapentin in rapid cycling bipolar disorder, mania and bipolar depression has been suggested by open trials, but these findings have not been replicated in two randomised controlled trials. 

Gabapentin T GABA effects Partial seizures, bipolar disorder, migraine, neuropathic pain Sedation, ataxia, j cognitive change f 1... 

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