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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by ed_uk on December 22, 2004, at 15:44:41
Has anyone used phenytoin for the treatment or prophylaxis of mania?
Am J Psychiatry. 2000 Mar;157(3):463-5.
Phenytoin as an antimanic anticonvulsant: a controlled study.Mishory A, Yaroslavsky Y, Bersudsky Y, Belmaker RH.
Stanley Center for Bipolar Research, Ministry of Health Mental Health Center, Ben Gurion University of the Negev, Beersheva, Israel.
OBJECTIVE: Phenytoin, a classical anticonvulsant, shares with antimanic anticonvulsants the property of blockade of voltage-activated sodium channels. The authors therefore planned a trial of phenytoin for mania. METHOD: Patients with either bipolar I disorder, manic type, or schizoaffective disorder, manic type, entered a 5-week, double-blind controlled trial of haloperidol plus phenytoin versus haloperidol plus placebo. Of 39 patients, 30 completed at least 3 weeks and 25 completed 5 weeks. RESULTS: Significantly more improvement was observed in the patients receiving phenytoin. Added improvement with phenytoin in scores on the Brief Psychiatric Rating Scale and Clinical Global Impression was seen in the patients with bipolar mania but not those with schizoaffective mania. CONCLUSIONS: Blockade of voltage-activated sodium channels may be a common therapeutic mechanism of many anticonvulsants given for mania, and phenytoin may be a therapeutic option for some manic patients.
Bipolar Disord. 2003 Dec;5(6):464-7.
Prophylactic effect of phenytoin in bipolar disorder: a controlled study.Mishory A, Winokur M, Bersudsky Y.
Barzilai Hospital, Ashkelon Faculty of Health Sciences, Ministry of Health, Mental Health Center, Ben Gurion University of the Negev, Beersheva, Israel.
OBJECTIVE: Phenytoin is an effective anticonvulsant that has not previously been studied prophylactically in bipolar (BP) patients. Thus a study of phenytoin prophylaxis was undertaken and is herein reported. METHOD: Bipolar patients were studied who had at least one episode per year in the previous 2 years despite ongoing prophylaxis. Patients were stable for a mean of 4 months (range 1-13) before entering the study. Phenytoin or placebo was added to their current therapy in a double-blind cross-over design for 6 months in each phase. Thirty observation periods of 6 months each were studied for 23 patients. RESULTS: Three patients had relapse on phenytoin and nine had relapse on placebo. There was a significant prophylactic effect of phenytoin in BP disorder [Cox's F-test for comparing survival in two groups: F(6, 18) = 3.44, p = 0.02]. CONCLUSIONS: This study suggests prophylactic effects of add-on phenytoin in BP illness. However, the number of patients was small and confirmation is necessary.
Posted by ed_uk on December 22, 2004, at 16:54:19
In reply to Phenytoin (Dilantin / Epanutin) for mania, posted by ed_uk on December 22, 2004, at 15:44:41
Has anyone ever treated their mania with phenobarb or primidone???
Barbiturate anticonvulsants in refractory affective disorders.Hayes SG.
Department of Psychiatry, University of Southern California School of Medicine.
Despite an increasing literature demonstrating both acute and long-term positive psychopharmacological effects of both valproate and carbamazepine, phenytoin has remained a controversial intervention, and barbiturate anticonvulsants have generally received poor press with regard to psychotropic effects. In the present investigation, 27 seizure-free, affectively ill patients who received therapeutic trials of primidone and/or mephobarbital after failing on antidepressants, lithium, carbamazepine, valproate, and phenytoin were analyzed with regard to effects on illness severity and affective cycle rate over a period of as long as four years. Nine (33%) of the patients had a sustained positive therapeutic effect on affective state and/or psychotic symptoms to primidone and three (11%) had positive effects on mephobarbital after primidone failure. Four (15%) had brief positive effects that were not sustained, and the remaining 11 (41%) had no effects or negative effects to these agents. The theoretical and practical implications of this new and unexpected finding are discussed.
The use of primidone in the treatment of refractory bipolar disorder.
Schaffer LC, Schaffer CB, Caretto J.
Sutter Community Hospitals, Sacramento, California, USA.
Four anticonvulsant medications (carbamazepine, valproate, gabapentin and lamotrigine) have received attention in the psychiatric literature as efficacious treatment for bipolar disorder, either as monotherapy or as adjunctive agents. Although two earlier reports in 1993 suggested that primidone may also be helpful for bipolar disorder, this older anticonvulsant has not been evaluated in any subsequent studies to confirm these earlier findings. In the present prospective open study, 26 patients with refractory bipolar disorder were treated with primidone as an adjunctive therapy. Eight (31%) patients experienced a persistent positive therapeutic effect. Five (19%) patients were considered partial or temporary responders to primidone. The remaining 13 patients (50%) were considered treatment failures. Although a 31% response rate is considered modest in most psychotropic medication studies, the authors believe that this success rate is significant in this refractory patient population and should provide impetus for future more scientific studies to confirm the preliminary findings of this open trial.
Posted by gromit on December 25, 2004, at 3:20:57
In reply to Phenytoin (Dilantin / Epanutin) for mania, posted by ed_uk on December 22, 2004, at 15:44:41
> Has anyone used phenytoin for the treatment or prophylaxis of mania?
I took it as a small child for seizures and man the stuff was horrible. I stopped taking it without telling my parents and learned how not to have a seizure, that may sound ridiculous but it's true. I had a simular reaction to depakote this year, I really feel if I had continued it would have killed me. The 200 mg lamictal I take now is transparent, I don't even notice it. Go figure...
Rick
Posted by ed_uk on December 25, 2004, at 8:00:12
In reply to Re: Phenytoin (Dilantin / Epanutin) for mania, posted by gromit on December 25, 2004, at 3:20:57
Hi!
What side effects did you have from phenytoin and Depakote?
In England, phenytoin is mainly used for elderly people with epilepsy who've taken it for decades, the same is true of primidone!
How did you learn to control your seizures?
Ed.
Posted by linkadge on December 25, 2004, at 15:52:58
In reply to Re: Phenytoin (Dilantin / Epanutin) for mania » gromit, posted by ed_uk on December 25, 2004, at 8:00:12
In what ways do you say it would've killed you. Do you mean emotionally ??
I am taking depakote now and am finding it very difficult to tollerate. THe stuff makes me feel very low and incapable.
Linkadge
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