Introduction and history

Prior to the mid-nineteenth century, epilepsy was viewed as a form of demonic possession and was commonly treated with exorcism. In the mid-1800s, the discovery of the antiepileptic properties of bromides revolutionized the treatment of epilepsy. Since then, barbiturates, phenytoin, benzodiazepines, carbamazepine, valproate, and several other antiepileptic drugs have been introduced.

Psychiatric patients, like patients with epilepsy, were also thought to be possessed by demons. Interestingly, many of the same medications used to treat epilepsy are now being used to treat some psychiatric disorders, particularly bipolar disorder. At present, we have a limited understanding of the mechanisms of action of the antiepileptic drugs in seizure disorders, but our understanding of their actions in psychiatric disorders is even less clear.

This chapter will review the antiepileptic drugs frequently used in psychiatry, including valproate, carbamazepine, oxcarbazepine, gabapentin, and lamotrigine (see

Fig 1 for the structures of these drugs and Table.,! for their available dosage forms). Practical aspects of their use will be emphasized However, studies documenting treatment efficacy will not be extensively reviewed, as these will be covered in the respective chapters on the various disorders. The benzodiazepines, which are the most commonly used antiepileptic drugs in psychiatry, are discussed in Chapter 6.6. Phenytoin is rarely used in psychiatric disorders, and therefore will not be included in this chapter.

Fig. 1 Molecular structures of selected antiepileptic drugs: (a) valproate; (b) carbamazepine; (c) oxcarbazepine; (d) gabapentin; (e) lamotrigine.

Table 1 Available dosage forms of antiepileptic drugs

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