Effects of carbamazepine on noradrenergic mechanisms in affectively ill patients

The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation

The chronic, complex, and episodic course of bipolar mood disorder presents a particularly formidable challenge to the clinician making a treatment plan for the onset or recurrence of the illness during pregnancy and lactation. Women treated with anti-manic drugs who become pregnant are commonly considered to be at high risk for fetal complications during the pregnancy or during lactation. The risks of antimanic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, and the potential for longer-term neurobehavioral sequela. The use of medications during pregnancy and lactation requires critical attention to the timing of exposure, dosage, duration of use, and fetal susceptibility. The postnatal period is a time of increased onset and relapse of mental illness. No antimanic drug can be proven completely safe. Prescribing antimanic medications with a long safety record, avoiding exposure in the first trimester; avoiding multidrug regimens, and prescribing the lowest dose for the shortest duration will minimize the fetal risk. This review considers treatment with lithium, valproic acid, and carbamazepine. It assesses the risk to the fetus, the perinatal risks for the infant, the risks associated with treatment during the puerperium and breast-feeding, and the risks to the later development of the child.

Possible relationships between plasma carbamazepine-10,11-epoxide levels and antimanic efficacy and side effects in patients with schizoaffective disorde

We examined the relationships of plasma levels of carbamazepine (CBZ) and its two major metabolites, carbamazepine-10,11-epoxide (CBZ-E) and carbamazepine-10,11-diol (CBZ-D), with antimanic efficacy and side effects in patients with schizoaffective disorder. Positive relationships were found among plasma concentrations of CBZ-E and the degree of clinical improvement and side effects, whereas neither plasma CBZ nor CBZ-D levels were correlated with the degree of clinical improvement or side effects. Copyright 2000 John Wiley & Sons, Ltd.

Administration of carbamazepine in the nucleus of the solitary tract inhibits the antihypertensive effect of clonidine

The effects of carbamazepine administration into the nucleus tractus solitarii (NTS) on central alpha 2-adrenergic cardiovascular function were studied in normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR). Stereotaxic microinjections of carbamazepine (288 ng/60 nl) into the NTS of SHR transiently increased blood pressure, heart rate, and renal sympathetic nerve activity. These effects were followed by a modest depressor and bradycardic effect, with no change in sympathetic nerve activity. In addition, previous intra-NTS administration of carbamazepine attenuated the antihypertensive effect of the centrally acting alpha 2-adrenoceptor agonist, clonidine. Similar carbamazepine effects were observed in the WKY rats. These results suggest that some of the cardiovascular changes observed during carbamazepine treatment involve antagonism of central noradrenergic mechanisms.

The effects of carbamazepine on resting metabolic rate and thyroid function in depressed patients

Resting metabolic rate and thyroid hormone levels were studied in 11 patients with affective disorders before and during treatment with carbamazepine (CBZ). CBZ has been previously reported to reduce thyroid hormones, but the metabolic consequence of this effect has not been explored. During CBZ treatment, thyroid hormones decreased significantly (T4, 7.53 versus 5.74 micrograms/dl, p less than 0.001), whereas the resting metabolic rate (RMR) did not (31.6 versus 30.7 kcal/m2/hr). Baseline RMRs were low and the expected positive relationship between RMR and weight was disrupted in females. The extent of previous exposure to tricyclic and monoamine oxidase inhibitors antidepressant treatment was significantly associated with lower baseline RMRs. We conclude that CBZ has no significant effect on RMR despite robust decreases in thyroid function.