Book Review

Anticonvulsants in Mood Disorders

N Engl J Med 1995; 333:72July 6, 1995

Article

Anticonvulsants in Mood Disorders
(Medical Psychiatry. Vol. 2.) Edited by Russell T. Joffe and Joseph R. Calabrese. 244 pp. New York, Marcel Dekker, 1994. $99.75. ISBN: 0-8247-9260-2

Of those with bipolar disorder (formerly known as manic-depressive illness), only half have a good response to lithium carbonate, the first and best-known mood stabilizer, available in the United States since the early 1970s. Thus, the discovery that certain anticonvulsants (valproic acid and carbamazepine) control bipolar (especially manic) symptoms has been one of the more important psychopharmacologic advances of the past 15 years.

This book is a useful update of this area of psychiatry. Because it focuses on mood disorders (and predominantly bipolar mood disorders), it has a narrower scope than a previous book on this topic (S.L. McElroy and H.G. Pope, eds. Use of Anticonvulsants in Psychiatry: Recent Advances. Clifton, N.J.: Oxford Health Care, 1988). However, I was rather surprised to find that electroconvulsive therapy, the first effective anticonvulsant treatment in psychiatry (available since the 1930s), was barely mentioned (in three paragraphs in the last chapter, ``Miscellaneous Anticonvulsants in Affective Disorders''). Research on electroconvulsive therapy is booming, with a dedicated peer-reviewed journal, and the treatment arguably remains the most effective mood-stabilizer available.

The book covers important theoretical, technical, and clinical aspects of mood-stabilizing anticonvulsants. There are nine chapters, of which three deal with valproic acid (pharmacology and physiology in chapter 2, mechanism of action in chapter 4, and clinical efficacy in chapter 6) and three with similar aspects of carbamazepine (chapters 3, 5, and 7). Two chapters (1 and 8) take up the use of anticonvulsants in rapid-cycling bipolar disorder (a severe form of bipolar disorder characterized by the occurrence of four or more episodes per year) and mixed or dysphoric mania, two of the most difficult to treat (and often lithium-resistant) subtypes of mood disorders. The last chapter is a brief review of the usefulness of miscellaneous anticonvulsants (benzodiazepines and electroconvulsive therapy) or drugs with putative anticonvulsant properties (calcium-channel blockers).

This book appears to be directed mainly at psychiatrists with considerable familiarity with the various subtypes of mood disorders. For example, the first chapter (even the first sentence) mentions rapid cycling. This is the equivalent of starting a book about baseball with a chapter on triple plays. I enjoyed the book but would nevertheless have preferred to see an introductory historical and clinical overview for the nonpsychiatric reader (such as a primary care physician) to help set the stage for the complex technical chapters that follow.

The references are comprehensive and generally up to date. However, because of the considerable overlap in citations, it would have been preferable to combine the references into a single alphabetical section at the end.

The authors and coauthors include some of the best-known researchers in the field of neurobiology and pharmacologic management of bipolar disorder. The style is generally scholarly, the text is informative, and the book is generously sprinkled with tables and figures. Still, it can be heavy reading for nonaficionados. Also, the $100 price, rather steep for such a small book, may discourage some potential buyers.

Henry A. Nasrallah, M.D.
Ohio State University, Columbus, OH 43210