Carbamazepine vs lithium or combination Authors: Denicoff KD, et al. Title: Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. Reference: J Clin Psychiatry 1997;58:470–8. Purpose: To compare the efficacy of lithium, carbamazepine, and the combination of both for prophylaxis of bipolar disorder. Study design: Prospective, randomized, double-blinded, cross-over trial. Follow up: 3 years. Patients: 52 outpatients initially recruited. Treatment: 1-year monotherapy of lithium or carbamazepine, followed by 2nd-year cross-over to other drug and 3rd-year combination of both treatments. Results: 33.3% patients receiving lithium, 31.4% receiving carbamazepine, and 55.2% receiving the combination showed improvement of the CGI scale (not significantly different). Lithium was more effective than carbamazepine in the prophylaxis of mania. Patients with a past history of rapid cycling did significantly better on combination therapy.
