Antiepileptic drugs in the treatment of impulsivity and aggression and impulse control and cluster B personality disorders

We review here evidence that suggest that antiepileptic drugs (AEDs) (a.k.a. anticonvulsants) may be effective for the treatment of impulsivity and aggression across a range of psychiatric disorders. AEDs are increasingly used as primary or adjunctive treatments for impulse control disorders (ICDs) and cluster B personality disorders [in particular borderline personality disorder (BPD)]. Thus, in addition to the reviewing the effects of AEDS on the symptoms of impulsivity and aggression across a variety of diagnoses, we will focus on ICDs and BPD. The AEDs valproate (e.g., divalproex sodium), carbamazepine, and lamotrigine have U.S. Food and Drug Administration (FDA) indications for the treatment of bipolar disorder. Other AEDs, like oxcarbazepine, gabapentin, topiramate, levetiracetam, phenytoin, and tiagabine, are often used as mood stabilizers but do not have FDA indication for bipolar disorder. Use of off-label AEDs requires careful monitoring and publication of all significant results, including adverse effects. The choice of specific AED is often dependent on drug-drug interactions and side-effect profile (1). Side effects from AEDs are typically mild to moderate. Although data regarding longerterm safety of the newer AEDs are limited, they may have more desirable side-effect profiles.