This retrospective single-case study demonstrates the development of
tolerance and reresponse to carbamazepine in a patient with coexisting
trigeminal neuralgia and manic-depressive illness. After an initial
positive response, tolerance to the antinociceptive and psychotropic
effects of carbamazepine appeared during treatment, despite increasing
doses. As in preclinical studies of contingent tolerance, periods of
carbamazepine discontinuation were associated with reresponse following
reinstitution. These are the first clinical data interpreted in a
contingent tolerance formulation with reresponse following a medication-
free interval. Controlled and prospective studies are needed of the
reliability and the pathophysiological and therapeutic implications of this
phenomenon.
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