Carbamazapine was one of the first anticonvulsant drugs studied in bipolar disorder and, together with lithium and valproate, is considered to belong to the first generation of mood stabilizers.  Like most other mood stabilizers, it is more effective in preventing mania than depression.  The drug is often considered a second-line choice due to perception of modest efficacy (inferior to lithium in some studies), side effects (some rare but serious) and potential for drug interactions (affects the clearance of many other drugs).  The drug is available as a generic in many markets and so there is little promotional presence in the bipolar market by the originator company, Novartis. 

Strengths:

• Has been used for many years. Well known by physicians. 
• Some evidence from clinical trials of efficacy in the maintenance of bipolar disorder.

Weaknesses:

• Not approved for use in bipolar disorder in all markets.
• Strong pharmacokinetic interaction with many other medications.
• Teratogenic – not recommended for use in pregnancy. 
• Risk of agranulocytosis (clinical vigilance and periodic blood counts are prudent). 
• Risk of skin rash (similar to lamotrigine). 
• Not as effective as lithium.