MOOD STABILIZERS
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)
Topomax (topiramate)
Gabitril (tiagabine)
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 "theraputic" 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 menstral 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 anti-aggressive 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, TOPOMAX, and GABITRIL:
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.
Topomax is chemically unrelated to any other anti-convulsant or mood stabilizing
medication. Some clinicians believe that a patient on Tompomax 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 its
effectiveness, but it is being prescribed more and more in the treatment of
bipolar disorder.