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Carbamazepine and Lithium Carbonate in the Treatment of Refractory Affective Disorders

Robert Keisling, MD
Arch Gen Psychiatry. 1983;40(2):223. doi:10.1001/archpsyc.1983.01790020121015.
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To the Editor.—  Several reports in the Japanese and American literatures show carbamazepine to be effective in relieving affective disorders.1-6 Three cases recently treated in our facility lend support to this finding.

Report of Cases.—  Case 1.—A 25-year-old man had had seven hospitalizations during the past five years. He was believed to have a schizoaffective disorder and had received treatment with neuroleptics and psychotherapy, with poor results. The patient exhibited paranoid and grandiose delusions, aggressive and assaultive behavior, and insomnia. While receiving neuroleptics, he became depressed, withdrawn, apathetic, and lethargic, without evidence of a thought disorder. When placed on a regimen of antidepressants (amitryptiline, desipramine), he would become either catatonic or aggressive and assaultive. Lithium carbonate provided no improvement in the depressive symptoms (lithium carbonate levels, 0.8 to 1.3 mEq/ L).The patient was readmitted to our facility in an agitated, paranoid state. As usual, oral haloperidol, 20 mg


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