Use of antiepileptic drugs in mental disorders

Antiepileptic drugs (AEDs) are quite often used in psychiatric practice and are considered the drugs of choice for mental disorders, primarily recurrent and bipolar depression and mania, behavioral and anxiety disorders with signs of bipolar emotional dysregulation, mental disorders with dependence on psychoactive substances. The level of evidence for the use of AEDs varies, sometimes they are used outside the recommendations of the FDA, EMA, outside the instructions of the Pharmcenter of Ukraine. Currently, mood stabilizers such as valproate, lamotrigine, carbamazepine have the highest level of evidence. Most psychotropic drugs are recommended for use in the treatment of affective disorders (antipsychotics, antidepressants, lithium salts) and attention deficit hyperactivity disorders (psychostimulants, atomoxetine) from the age of 6, which explains the widespread use of valproate and lamotrigine in pediatric practice outside direct indications. Bipolar affective disorders have a high level of comorbidity with generalized anxiety and panic disorder, which sometimes demonstrate low sensitivity to benzodiazepine therapy, but respond well to valproic acid salt therapy. The use of gabapentin in anxiety disorders is based on the results of controlled studies. Anticonvulsants are widely used in alcohol and substance abuse, addictive disorders, emotional and behavioral disorders associated with withdrawal states. The therapeutic and side effects of AEDs are closely related to behavioral disorders in epilepsy. They can improve or worsen behavioral symptoms associated with signs of emotional bipolar dysregulation and attention deficit hyperactivity disorder. It is expected that the list of AEDs will continue to grow, and new proposals for use in psychiatric practice will appear.