Mood disorders in the psychoneurologic borderland: three cases of responsiveness to carbamazepine

Three patients with affective disorders with psychotic features were refractory to various combinations of psychotropic agents (antipsychotics, antidepressants, and lithium). Closer scrutiny revealed a seizure history in two patients and unusual neuropsychiatric features in the third patient. Subsequent substitution of carbamazepine for the antipsychotic resulted in control of the patients' psychoses. The authors describe clinical features that may identify the patient who may respond to carbamazepine. The mechanism of carbamazepine's psychotropic effects through its hypothesized ability to inhibit limbic system kindling is discussed. The case reports emphasize the need for careful neuropsychiatric assessment of patients who are refractory to conventional treatments.