Mood-stabilizing medications for bipolar disorder
Examples
Generic Name Brand Name lithium carbonate Carbolith, Duralith, Lithane The above medications are taken as tablets or capsules (orally).
Generic Name Brand Name carbamazepine Tegretol divalproex sodium Epival lamotrigine Lamictal valproate sodium Depakene syrup These medications are available in syrup, tablet, capsule, and chewable tablet forms.
How It Works
Mood stabilizers balance certain brain chemicals (neurotransmitters) that control emotional states and behaviour.
Valproate and divalproex have been approved as treatments for acute manic episodes in bipolar disorder.1 Lamotrigine is also prescribed for the long-term maintenance treatment of bipolar I disorder as an off-label use. These medications, which are also called anticonvulsants, have been used for some time to treat seizures.
Why It Is Used
Lithium is usually one of the first medications prescribed for bipolar disorder to treat mania and to prevent the return of both manic and depressive episodes.
Valproate, divalproex sodium, lamotrigine, and carbamazepine may be used during a manic episode or to prevent mood cycling between depression and mania.
Valproate may be taken along with lithium carbonate or antidepressants to avoid a depressive episode. Valproate is also used during manic episodes for people who do not respond well to lithium carbonate alone.
Carbamazepine is used to treat mania and may be used in people who cannot take or don't respond to lithium or valproate.
How Well It Works
Lithium carbonate may provide relief from acute episodes of mania or depression and can help prevent them from recurring.
Lithium is often helpful in treating manic episodes that are not mixed with any depressive mood.2 Long-term use of lithium has been shown to reduce the risk of suicide related to bipolar disorder.1
Divalproex has been shown to help reduce rapid cycling between moods and is effective in those with bipolar disorder who also have substance abuse or anxiety problems.2
Initial research indicates that lamotrigine is effective in treating both depression and mania associated with bipolar disorder.2 Lamotrigine improves mood, alertness, and the way you relate to others. It has also been shown to be an effective treatment for rapid cycling.3 Lamotrigine is usually taken alone, without other medications normally used to treat bipolar disorder.
Side Effects
Side effects of lithium may include:
- Nausea, vomiting, and diarrhea.
- Trembling.
- Increased thirst and increased need to urinate.
- Weight gain in the first few months of use.
- Drowsiness.
- A metallic taste in the mouth.
- Abnormalities in kidney function.
- Abnormalities in thyroid function.
More serious side effects of lithium can include blacking out, slurred speech, changes in heart rhythm or a heart block, and an increase in the number of white blood cells (not usually because of an infection).
Side effects of valproate may include weight gain, drowsiness, low energy, stomach upset, changes in liver function, and problems with platelet functioning (thrombocytopenia). Uncommon side effects can include temporary hair loss, headaches, and confusion.
A warning label has been added to valproate injections and divalproex tablets and capsules that warns of a potential increase in pancreatitis associated with the use of these products. A recent study connected long-term use of valproate to the development of polycystic ovary syndrome in women.4 Using valproate during pregnancy significantly increases the risk of birth defects, including spina bifida; therefore, women of child-bearing age should use birth control or avoid becoming pregnant while on valproate and should take folic acid (4 mg a day) to prevent birth defects should they unexpectedly become pregnant.
Lithium carbonate also increases the risk of birth defects during pregnancy.5
Lamotrigine was well-tolerated by people in initial studies. Some side effects occurred, including headaches, sleepiness, weight gain, and, most seriously, Stevens-Johnson syndrome, which causes dangerous sores on the mucous membranes of the mouth, nose, genitals, and eyelids.. Serious negative side effects were uncommon. Rare side effects can include dizziness, blurred vision, nausea and vomiting, liver function problems, and most seriously, Stevens-Johnson syndrome.
Side effects of carbamazepine may include nausea, vomiting, diarrhea, Stevens-Johnson syndrome, dizziness, blurred vision, drowsiness, and headache. Carbamazepine should not be taken during pregnancy.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Do not stop taking these medications suddenly. You should taper off of these drugs slowly with the help of your doctor to avoid negative and serious side effects.
High blood levels of lithium carbonate can be life-threatening. People who take lithium carbonate need to have their blood checked regularly to measure the amount of the drug in their blood.
Your doctor will need to periodically test the function of your kidneys and thyroid gland if you are taking lithium.
Sometimes other medications cause higher- or lower-than-expected amounts of lithium carbonate in a person's blood. People who take lithium carbonate need to tell their doctors if they take other medications.
Some mood stabilizers may interact negatively with other medications. Be sure to talk with your doctor about any medicines you are taking.
Your doctor may want you to have regular blood tests while on valproate, divalproex, lamotrigine, or carbamazepine to check your medication levels, liver function, and blood counts.
If you have been taking antidepressants but have not been able to control your episodes of depression or mania, you may want to ask your doctor about taking lamotrigine to treat bipolar disorder.
Making the decision about which medications to use can be a very complicated issue in the treatment of bipolar disorder. Be sure to discuss all the options and side effects with your doctor. You may have to try several medications or combinations of medications before finding what works best for you.
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| Author: | Carrie Henley Sabra L. Katz-Wise | Last Updated: July 31, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Malin K. Clark, MD, FRCPC - Psychiatry Lisa S. Weinstock, MD - Psychiatry | |
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| Topic Contents | |
| Examples | |
| How It Works | |
| Why It Is Used | |
| How Well It Works | |
| Side Effects | |
| What To Think About | |
| References | |