Mood Stabilizers

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Although some mood stabilizers can help with the symptoms of depression that people with bipolar experience, 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)

LITHIUM:
This medication 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 because too little lithium isn't effective in stabilizing mood swings and too much can be toxic.

For "rapid cyclers" or for those that cannot tolerate lithium, Tegretol and Depakote are usually effective alternatives.

DEPAKOTE:
This is an anticonvulsant drug that was recently 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 valproic acid (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 that has acute antimanic effects and has also been established to have antiaggressive properties, something that makes it particularly useful in treating children with bipolar disorder, is Tegretol. 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 antimanic 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 antimanic medications: It is frequently effective for controlling "rapid cycling" and mixed states, it seems to work in the depressed phase of bipolar disorder, and it does not appear to cause 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 rash that in some instances is associated with a life-threatening syndrome known as Stevens-Johnson syndrome. This is a severe and sometimes fatal allergic reaction to an infectious disease or a drug. 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, and there is little known yet about the its effectiveness, but it is being prescribed more and more in the treatment of bipolar disorder.

Trileptal is becoming more and more 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 cells like Tegretol does. Once more evidence of its effectiveness is established, this medication may become a first line treatment for mood stabilization.