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Carbamazepine and Lithium Carbonate Synergism in Mania

Gene Richard Moss, MD; Charles R. James, PHD
Arch Gen Psychiatry. 1983;40(5):588-589. doi:10.1001/archpsyc.1983.01790050114020.
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To the Editor.—  Lipinski and Pope1 and Forrest2 have described four patients with acute mania who appeared to respond favorably to a combination of lithium carbonate and carbamazepine. We report a favorable but brief response to that combination in a patient who had not responded adequately to either drug alone.

Report of a Case.—  A 35-year-old, divorced man with a nine-year history of major affective disorder, manic type, had a ten-year psychiatric history that included multiple psychiatric hospitalizations. He had undergone a variety of therapeutic regimens, including electroconvulsive therapy. With lithium carbonate therapy alone, the patient would exhibit what had come to be a familiar pattern of psychotic decompensation, including insomnia, agitation, flight of ideas, and excessive religiosity. For several years before admission, he had been receiving maintenance therapy with lithium carbonate (1,500 mg/day) and haloperidol (10 mg/day). Serum lithium levels, measured repeatedly over the years, had consistently

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