Safety and tolerability of mood-stabilising anticonvulsants in the elderly

Abstract

The authors review current research on the safety and tolerability of anticonvulsant medications used for individuals over the age of 60 years with affective disorders, agitation and other psychiatric disorders. Three anticonvulsants currently approved in the US for treatment of bipolar affective disorder are reviewed: valproate, lamotrigine and extended-release carbamazepine. The authors discuss the pharmacokinetics, pharmacodynamics, drug–drug interactions and the impact of ageing for each drug. There are few studies of anticonvulsant medications in elderly patients with bipolar disorder or other psychiatric conditions. Therefore, the authors summarise adverse events of greatest prevalence and/or greatest severity based on data derived predominately from studies of geriatric patients with epilepsy and/or other non-psychiatric indications. Guidelines are offered for the safe use of these medications in the elderly, based on research literature.

Keywords::

• bipolar affective disorder
• carbamazepine
• elderly
• geriatric
• lamotrigine
• mania
• mood instability
• valproate

Notes

(?) Indicates probable interaction.

Adapted from Ketter TA, Wang PW, Post RM: Carbamazepine and oxcarbazepine, in The American Psychiatric Press Textbook of Psychopharmacology (3^rd edition), Schatzberg AF, Nemeroff CB (Eds). American Psychiatric Press, Washington, DC (2003):581-606 [123]. CBZ: Carbamazepine; OXC: Oxcarbazepine.