Preliminary Observations on the Effectiveness of Levetiracetam in the Open Adjunctive Treatment of Refractory Bipolar Disorder
J Clin Psychiatry 2005;66(3):370-374
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Levetiracetam is a recently approved,
well-tolerated anticonvulsant with a unique mechanism of action
yielding efficacy in treatment-refractory seizure disorders and
positive effects in an animal model of mania. Given the
effectiveness of a range of other anticonvulsants in bipolar
disorder, we sought to evaluate levetiracetam in patients with
Method: Thirty-four patients received 500 to
1000 mg of levetiracetam titrated to a target dose of 2000 mg/day
(maximum dose = 3000 mg/day) as open, adjunctive treatment for
clinically significant symptoms of depression (N = 13), mania (N
= 7), or cycling (N = 14) despite ongoing treatment with mood
stabilizers. Inventory for Depressive Symptomatology-Clinician
version (IDS-C), Young Mania Rating Scale (YMRS), and Clinical
Global Impressions scale for use in Bipolar Illness ratings were
completed at each visit for 8 weeks, and partial responders were
offered continuation treatment. Data were collected from July
2001 to December 2002.
Results: Five of 16 (31%; 13 depressed, 3
cycling) patients with initial depressive symptoms met the
criterion for remission (IDS-C score of <= 13) at last
observation. All of these patients were less severely ill at
baseline, whereas none of those more severely depressed at
baseline responded. The majority of the 16 patients (7 manic, 9
cycling) with manic symptoms at baseline showed improvement in
the YMRS in the first 2 weeks. While 7 of the 16 (44%) patients
met the criterion for manic response and remission at last
observation, 4 showed intervening periods of moderate to marked
exacerbation. Levetiracetam was weight neutral.
Conclusion: Other pilot trials should explore
possible areas of psychotropic action of levetiracetam prior to
the conduct of more controlled clinical trials.