Table 1.

Comparison of Various Treatment Modalities in Chronic Pain and Bipolar Disorder

Drug	Efficacy Supported by APA Bipolar Disorder Guidelines	Efficacy in Neuropathic Chronic Pain (Cochrane Database)	Weight Gain Potential	Other Potential Issues
Lithium	Yes	None	Moderate	May interact with NSAIDS
Valproate	Yes	Low to none	Moderate	Approved for migraine headache use
Carbamazepine	Yes	Robust	Low	High drug interaction potential
Lamotrigine	Yes	Low to none	Low	Slow titration
Second-generation antipsychotics	Yes	Low to none	Low to high	Metabolic issues
SNRI and tricyclic antidepressants	Avoidance advised	Robust	Low	Destabilizing effects in bipolar disorder
Gabapentin and pregabalin	Weak to none, adjunctive use only	Robust	Low	Low side effect profile

Abbreviations: APA = American Psychiatric Association, NSAID = nonsteroidal anti-inflammatory drug, SNRI = serotonin-norepinephrine reuptake inhibitor.