Magazine article Clinical Psychiatry News

Mechanisms of Action: The Interchangeable (Mis)use of Anticonvulsants

Magazine article Clinical Psychiatry News

Mechanisms of Action: The Interchangeable (Mis)use of Anticonvulsants

Article excerpt

Historically, psychotropic drugs have been classified based on the primary disorder they were designed (or found) to treat. Today, such labels seem to be outdated, as a particular agent may be an effective treatment for specific symptoms as opposed to a specific disorder, and in turn may alleviate those symptoms across diagnoses. Although agents within a designated class may share some therapeutic effects, each one may not treat the exact same symptom profile. The most notable example of this is the anticonvulsants. These agents were categorized together because they share a common therapeutic effect--namely, the ability to reduce seizures. However, the "class" of anticonvulsants is actually made up of distinct agents with unique mechanisms of action, and thus, each agent may not be an effective treatment for the same symptom domains.

Specific agents, specific symptoms

For example, both divalproex and lamotrigine have demonstrated efficacy in treating bipolar disorder; however, divalproex may be more effective treatment for manic episodes, whereas lamotrigine may be more effective treatment for depressive episodes and maintenance. Furthermore, other anticonvulsants, such as topiramate, gabapentin, and pregabalin may not have efficacy for any phase of the bipolar spectrum, but do show efficacy for preventing migraine (topiramate) and for anxiety and peripheral neuropathy (gabapentin and pregabalin).

This leads us to ask the question "What's in a name?" Should the clinical use of anticonvulsants be based on nomenclature? Or should each anticonvulsant only be used to treat the symptoms for which it has demonstrated efficacy? …

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