Clinical trials have shown that carbamazepine has efficacy in the prophylaxis of bipolar episodes. There is some evidence for the inferiority of carbamazepine compared with lithium.

Strengths:

• Has been used for many years and is 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.

GSK counterclaim:

• Less effective in treating depression than mania.

Guidelines