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Psychiatric Uses of Anticonvulsants

College of Pharmacy, The University of Texas, Austin, Texas 78712

Anticonvulsants are being used for psychiatric indications with increasing frequency. The potential indications for carbamazepine (CBZ), valproic acid (VPA), clonazepam, and phenytoin are reviewed, with emphasis on double-blind controlled studies where available. Dosage guidelines, adverse effects, and monitoring parameters are reviewed for each of these drugs. The pathophysiological basis for anticonvulsant effectiveness is presented for mood disorders and aggression. CBZ and VPA represent second and third line agents after traditional lithium therapy in bipolar disorder. Clonazepam may be effective in the acute treatment of manic agitation. These alternative agents, when used for appropriate indications, may help the clinician manage the treatment-resistant manic patient. CBZ is also effective for the treatment of aggression and potentially effective for alcohol withdrawal.

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