躁うつ病および症候性躁-，うつ状態に対するCarbamazepine（Tegretol）の効果

The Use of Carbamazepine (Tegretol) in the Control of Manic-Depressive Psychosis and other Manic, Depressive States

I．緒言

　いわゆる内因性精神病のなかで，躁うつ病は分裂病とともに，その生理的障害のメカニズムは明快には判っていない^1）。また，躁うつ病（以下MDIと略称する）の治療も，ことに躁病（相）や循環性MDIの場合，うつ病（相）よりも一般に困難である。近年phenothiazine誘導系にくわえて，lithium塩^2）3）が試用されるようになり，われわれも使用してみたが必ずしも効果に安定性があるとはいいがたいようである。

　Carbamazepine＝Tegretol〔5-carbamoyl 5 H-dibenzo(b,f)-azepin〕は，従来より向精神作用をもつ抗てんかん剤として，あるいは抗三叉神経痛剤として一般に知られている。Tegretolは化学構造上，精神身体調整剤のopipramol（Insidon）と同じdibenzoazepine核をもち，また抗うつ剤のimipramine（Tofranil）のiminodibenzyl核に近似した構造をもっている。このような特性をもっTegretolを躁病やMDIの治療に試用するに至ったのは，開放病棟しかもたないわれわれの窮した上での迷案であったが，予期以上の臨床効果が得られた。

　1. Ten manic-depressive psychosis, and 10 symptomatic manic-depressive states patients were treated by daily dosage of 200 mg to 600 mg of Tegretol for 1 to 11 months of period. Thirteen cases were treated by the combination therapy of other drugs, 7 cases solotherapy.

　Improvement of the manic or depressive symptom was seen in 9 patients, no effect was found in 1 patient. While, improvement was seen in 6 patients, no effect was found in 4 patients of symptomatic manic-, depressive states.

　2. Tegretol has been evaluated as a antiepileptic, and a analgesics for trigeminal neuralgia, we have found now, its preferential action too, for manic-depressive psychosis, especially manic phase. In effective cases, manic states were level-downedin a few days or weeks, and with a well self-controlled feelings patients have adapted to their circumstances for long times.

　Patients suffering from severe typical manic depressive psychosis were changed into mania Levis or melancholia Levis with normal activity.

　3. Tegretol seems to act to manic-depressive psychosis with the same mechanism that its preferentially acts to limbic structures in the antiepileptic point of view.

　4. Untoward effects were not found and there was no connection between EEG findings and the clinical effect of Tegretol in our cases.