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Relationship to Antidepressant Response

Robert M. Post, MD; Thomas W. Uhde, MD; James C. Ballenger, MD; Dulal C. Chatterji, PhD; Raymond F. Greene, MS; William E. Bunney, Jr, MD

Arch Gen Psychiatry. 1983;40(6):673-676.

Abstract
• Levels of carbamazepine and its -10,11-epoxide metabolite were measured in plasma and CSF of affectively ill patients treated only with carbamazepine for an average of 33 days at an average dosage of 1,055 mg/day. The CSF levels of carbamazepine were 2.06 µ/mL (ie, 31% of plasma levels, which equaled 6.55 µ/mL); CSF -10,11-epoxide concentrations averaged 0.91 µ/mL in 18 subjects (63% of those found in plasma). Carbamazepine levels in plasma or CSF were not related to degree of antidepressant or antimanic response. In contrast, concentrations of the -10,11-epoxide metabolite were correlated with the degree of antidepressant response. This preliminary study suggests the possibility that the -10,11-epoxide metabolite of carbamazepine may be related to the degree of clinical efficacy in affectively ill patients and may thus possess active psychotropic properties in man in addition to its reported anticonvulsant effects in animals.

(Arch Gen Psychiatry 1983;40:673-676)

Author Affiliations
From the Section on Psychobiology, Biological Psychiatry Branch, National Institute of Mental Health (Drs Post, Uhde, Ballenger, and Bunney), and the Pharmaceutical Development Services Section, Pharmacy Department, Clinical Center (Dr Chatterji and Mr Greene), National Institutes of Health, Bethesda, Md; and the Department of Behavioral Medicine and Psychiatry, University of Virginia Medical Center, Charlottesville (Dr Ballenger).

Footnotes
Accepted for publication Aug 23, 1982.

Reprint requests to Biological Psychiatry Branch, National Institute of Mental Health, 9000 Rockville Pike, Bldg 10, Room 3N212, Bethesda, MD 20205 (Dr Post).

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