Lithium is the drug of choice for the preventive treatment of manic-depressive illness, eventually in combination with neuroleptics andlor anti-depressants. However, about 30% of the patients show a bad or inadequate response, especially the rapid cyclars. Since about 10 years 4 studies have been published on the effectiveness of the anti-epileptic drug carbamazepine (tegretol ®). From these studies (two open and two controlled) carbamazepine seems to exert a lithium-like effect: ánd antimanic ánd antidepressive ánd preventive. Some patients, who were bad-responders on lithium, did respond on carbamazepine. In an open study 8 patients, with a lithium resistant manic depressive illness were treated with carbamazepine. 2 patients dropped out. The other 6 patients were treated for at least 5 months, and showed a partial or good response on carbamazepine. Detailed cases of these 6 patients are presented.