A 66-year-old patient with bipolar illness who is stable on venlafaxine (Effexor) 75 mg and lithium wants to discontinue both in favor of phenytoin (Dilantin) as a mood stabilizer. This therapy was proposed by Julian Whitaker, MD, director of the Whitaker Wellness Institute (www.whitakerwellness.com). Do any studies validate this therapy? Would it have an effect similar to that of other anticonvulsant mood modifiers?
—Frank Seck, DO, Gladwin, Mich.

Conceptually, phenytoin would work similarly to other anticonvulsants in the treatment of mood disorders. In fact, early evidence suggests that phenytoin may have some efficacy as treatment for acute mania (J Clin Psychiatry. 2003;64:408-409) and as adjunctive therapy in the prophylactic treatment of bipolar disorder (Bipolar Disord. 2003;5:464-467). However, it is not FDA-approved for use in bipolar disorder, nor has it been included in the “Practice Guideline for the Treatment of Patients with Bipolar Disorder” (Am J Psychiatry. 2002;159[4 Suppl]:1-50). Your patient’s current stability may call into question the utility of changing regimens at all, unless there are other compelling reasons, such as medication side effects or intolerance.
—Christopher Ruser, MD (113-18)

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