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Mood Stabilizers
Although some mood stabilizers can help with symptoms of bipolar depression, their main role in the treatment of the disease is in reducing the severity of manic symptoms and preventing episodes of mania in the future.
| Most often used Mood Stabilizers: |
Lithium
Depakote (divalproex sodium)
Tegretol (carbamazepine)
Neurontin (gabapentin)
Lamictal (lamotrigine)
Topamax (topiramate)
Gabitril (tiagabine)
Trileptal (oxcarbazepine)
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LITHIUM:
Lithium is the most commonly prescribed mood stabilizer and successfully reduces the number, intensity, and duration of manic episodes for 70 percent of those who take it. Common side effects of lithium include fatigue, slurred speech, muscle weakness, nausea, stomach cramps, weight gain, increased urination, slight hand tremor, acne, swelling of the ankles and wrists, and impotence or reduction in sexual ability. Achieving a therapeutic level of lithium in the blood (through blood tests performed every three months) is important. This is because too little lithium is not effective in stabilizing mood swings, while too much lithium can be toxic.
For rapid cyclers, or for those that cannot tolerate lithium, Tegretol and Depakote are usually effective alternatives.
DEPAKOTE:
Depakote is an anticonvulsant drug that is FDA approved for the treatment of manic episodes. Common side effects of Depakote include indigestion, nausea, vomiting, a change in menstrual periods, drowsiness, temporary hair loss, and weight gain. A very rare but serious side effect of Depakote is liver toxicity and failure. As a result, liver function tests must be performed before and during treatment with this drug.
TEGRETOL:
Another anticonvulsant effective for acute manic episodes that also shows anti-aggressive properties is Tegretol. This makes it particularly useful in treating children with bipolar disorder. Common side effects of Tegretol include dizziness, drowsiness, nausea, unsteadiness, and vomiting. Since Tegretol can cause life-threatening adverse reactions such as aplastic anemia, bone marrow depression, and decreased white blood cell count, your complete blood count must be monitored regularly while you are taking the drug.
NEURONTIN, LAMICTAL, TOPAMAX, GABITRIL, and TRILEPTAL:
These are all anticonvulsant medications that have gained attention in the last few years for their anti-manic effects.
Neurontin seems to have very few side effects, does not cause weight gain, and can be used safely with other medications needed by a patient with bipolar disorder.
Lamictal seems to have many advantages over other anti-manic medications. It is usually effective for controlling rapid cycling and mixed states, it seems to work in the depressed phase of bipolar disorder, and it rarely causes weight gain. Most people tolerate the drug well and experience minimal side effects, but there is one side effect of great concern to those taking Lamictal. Some people taking the drug develop a potentially fatal rash, known as Stevens-Johnson Syndrome. As a result, until further studies are done, the FDA has placed this drug on the black label: It is not to be given to children under the age of sixteen.
Topamax is chemically unrelated to any other anticonvulsant or mood stabilizing medication. Some clinicians believe that a patient on Topamax can take an antidepressant and resist any tendency to switch into hypomania or mania or to suffer increased speed or intensity of cycling, but this has yet to be proven.
Gabitril has not been widely studied yet, but it is being prescribed more and more in the treatment of bipolar disorder.
Trileptal is becoming increasingly popular as a treatment for bipolar disorder. This drug is nearly the same as Tegretol, but reports of side effects are less, and it does not decrease white blood cell counts like Tegretol. Once more evidence of its effectiveness is established, this medication may become a first line treatment for mood stabilization.
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