Sensitization, kindling, and anticonvulsants in mania.

Cocaine can induce manic syndromes ranging from mild hypomania to severe dysphoric and psychotic mania, in part depending on the number and duration of drug administrations. Repeated cocaine administration in animals results in increased motor (behavioral sensitization) and convulsive (pharmacologic kindling) responses. Study of these progressive syndromes in animals may provide insights into principles underlying the longitudinal evolution of manic syndromes in man, including the increased vulnerability to recurrence following successive episodes. Different phases in the evolution of behavioral sensitization are differentially responsive to neuroleptics while the same principle is evident for different anticonvulsants in kindling. The authors examine whether pharmaco-responsivity may also differ as a function of stage of progression of mania. Antimanic effects of lithium, neuroleptics, and the newer anticonvulsants, such as carbamazepine, valproic acid, and clonazepam, are discussed in this context.