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Ticularly in comparison to studies in largely pro-GABAergic ; may be a clini- independent of the number of prior unipolar depression. He noted the re- cal useful strategy. The combination depressions, as opposed to lithium, wherein more than three prior decent large, controlled studies of Dr. J. was well tolerated. Dr. K. Oedegaard University of pressive episodes appear to render it Calabrese and Dr. C. Bowden, which Bergen, Norway ; noted the high rate less effective. At least ten studies sugindicate that lamotrigine gest that patients with has better antidepressant Global Assessments of Anticonvulsants in Bipolar Illness more prior episodes do prophylactic effects than Based on SFBN1 Studies and the Literature not respond as well to lithium, but that lithium has lithium prophylaxis. In a better antimanic effects Category of randomized study in Inthan lamotrigine. Dr. J. Episode Efficacy Drug Mania Depression Prophylaxis Weight Gain dia, valproate proved Calabrese explored these Mania Depression 0 ECT + + " superior to prophylactic studies in CBZ + + + carbamazepine both in remore detail, emphasizing Mania Depression duction of mania scale the overall excellent tolerOXC + ; ? ? scores and in fewer adability of lamotrigine for VPA + + + verse effects. prevention of depression in ZON + ; + ; + ; - those who were recently These data indicate anmanic or recently de- Depression Mania other important reason for + + 0 LTG " pressed. initiating lithium The data of Dr. M. Frye Anti-manic? pharmacoprophylaxis as KLZ High-potency BZs ; + + + University of California at early as possible in the LOR Los Angeles ; and Dr. G. treatment of bipolar illGPN 0, + + Obrocea University of Non-antimanic ness. " GABAergic ; Southern California ; was Dr. J. Calabrese Case ? TIA 0 " " presented by Dr. R. Post; Western Reserve UniverTOP 0 + + - - these data compared ransity School of Medicine ; domized monotherapy To be determined commented that in conLEV ? + ; ? with lamotrigine to trast to his rapid cycling gabapentin and placebo for adult patients where reStanley Foundation Bipolar Network six weeks, with subsequent Key: + excellent; + very good; + good; " equivocal preliminary; 0 none; ? sponse to the lithium unknown; - - negative weight gain weight loss ; crossovers so that each pa- Abbreviations: ECT, electroconvulsive therapy; CBZ, carbamazepine; OXC, oxcarbazepine; VPA, valproic valproate combination is acid; ZON, zonisamide; LTG, lamotrigine; KLZ, clonazepam; LOR, lorazepam; LEV, levetiracetam; GPN, tient received each of the gabapentin; TIA, tiagabine; TOP, topiramate; BZs, benzodiazepines; GABA, gamma-aminobutyric acid quite low about 25% ; , in three drug phases. childhood onset bipolar Lamotrigine was superior to of comorbidity between bipolar II ill- illness this combination is highly and gabapentin and placebo for depres- ness and migraine, and suggested that rapidly effective in the majority of pasion and overall illness. Lamotrigine depressed patients with comorbid mi- tients as seen by Dr. R. Findling et improved subjective and cognitive graine had a clinical presentation more al. ; . components of depression, including like bipolar II than unipolar patients. These data are of considerable imguilt and pessimistic outlook for the Lamotrigine may also be a particularly portance in relation to several future; lamotrigine also decreased so- useful anticonvulsant for those neednaturalistic studies suggesting that matic concerns, but was not ing augmentation treatment with childhood onset bipolar illness has a significantly different from the other clozapine Clozaril ; , because it would poor prognosis. It may be that childtwo phases gabapentin or placebo ; not add to clozapine-induced weight hood onset bipolar illness is often on improving sleep disturbance gain like valproate would be more inadequately treated in the commu lamotrigine is slightly activating ; . likely to do. In a preliminary open nity and that more aggressive, Four of seven patients who had a study, lamotrigine did not appear to combination mood stabilizing therapy greater than two week exposure to be as effective in augmenting the antiis needed and highly effective. The the lamotrigine gabapentin combina- psychotics risperidone Rispetdal ; , data also suggest that interventions tion improved, suggesting that these olanzapine Zyprexa ; , or haloperidol early in childhood illness may yield two drugs with highly complemen- treatment, as it was for clozapine. higher responsiveness than later intary mechanisms of action terventions in adulthood after many Dr. C. Bowden University of Texas lamotrigine is largely anti- Health Science Center ; noted data more episodes have occurred. Continued on page 10 ; glutamatergic and gabapentin is showing that valproate's efficacy is.

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In one study, medication for 10 weeks; abstinence increased from 37% in control group to 89%. If subjects did drink, the number of drinks dropped from 9.5 to 2.5. With BEA being concentrated in the renal medullary interstitium, we speculate that BEA produces generalized sympathoexcitation via stimulation of afferent renal nerves Barajas et al., 1992; Petersen and DiBona 1995 ; . Several other groups have reported that BEA produces hypertension in the rat, but all previous observations have been performed daysto-weeks after BEA administration Susic et al., 1983; Tav erner et al., 1983, 1984, 1985; Russell et al., 1986; Dawson and Wallace, 1990 ; . Thus, whereas Na and fluid retention may be involved in the late development of BEA-induced hypertension see below ; , the mechanism s ; responsible for the immediate pressor response reported in this study is unknown. In untreated Dahl-S rats, MAP increased as anticipated when the NaCl content in the rat diet was changed from 1 to 4%. However, the increase in MAP in response to 4% NaCl was markedly accelerated in Dahl-S rats with renal papillary-medullary lesion. Similar findings have been reported in normotensive Long-Evans rats on a high dietary NaCl intake. Thus, Long-Evans rats with renal papillary-medullary lesion developed hypertension while arterial pressure in Long-Evans rats with intact renal medulla was not saltsensitive Susic et al., 1983 ; . With the accumulating evidence for a close relationship between increased medullary blood flow and pressure natriuresis, our findings are compatible with an impaired pressure-natriuresis relationship in the Dahl-S rat that deteriorates further when the renal medullary-papillary region is lesioned by BEA Roman 1986; Cowley and Roman 1996 ; . Thus, chronic administration of vasoconstrictor agents into the renal medulla e.g., vasopressin, for instance, rissperdal manufacturer. RISPERDALTh relationshto RISPERDAL therapy is imimoren. Rieperidone has en aitlematic elect to enimals this elleci may also coot to human and may mask slew and synitoms of oventoeage withcertaindrugsor and ritalin.
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