Anticonvulsant Medications for Bipolar Disorder

Several anticonvulsant medications are recognized as mood stabilizers to treat or prevent mood episodes in bipolar disorder. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.

Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling -- four or more episodes of mania and depression in a year.

Anticonvulsants used to treat bipolar disorder include:

• carbamazepine (Tegretol)
• divalproex sodium, valproic acid, or valproate sodium ( Depakote, Depakene )
• lamotrigine (Lamictal)

These medicines differ in the types of bipolar symptoms they treat. Depakote and Tegretol, for example, tend to be more effective in treating mania than depressive symptoms while Lamictal appears to have stronger antidepressant than antimanic effects. Lamictal also is used more often to prevent future episodes (rather than treat current episodes). Depakote and Tegretol are used to treat acute episodes more than as preventative treatments. Other anticonvulsants are less well-established for treating mood symptoms in bipolar disorder, and some -- such as Lyrica, Neurontin, or Topamax -- are also used "off label" for other types of problems such as sleep, pain management, anxiety or weight loss.

Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking them for several weeks.

Anticonvulsant Side Effects

Your doctor may want to take occasional blood tests to monitor your health while taking an anticonvulsant. Some anticonvulsants can cause liver or kidney damage or decrease the amount of platelets in your blood. Your blood needs platelets to clot.

Each anticonvulsant may have slightly different side effects. Common side effects generally include:

• Dizziness
• Drowsiness
• Fatigue
• Nausea
• Tremor
Rash
• Weight gain

Most of these side effects lessen with time. Long-term effects vary from drug to drug. In general:

• Pregnant women should not take anticonvulsants without consulting with their doctor, because some of these drugs may increase the risk of birth defects.
• Some anticonvulsants can cause problems with the liver over the long term, so your doctor may monitor your liver periodically.
• Anticonvulsants can interact with other drugs -- even aspirin -- to cause serious problems. Be sure to tell your doctor about any drugs, herbs, or supplements you take. Don't take any other substance during treatment without talking with your doctor.

Always talk to your doctor before stopping an anticonvulsant. Sometimes, stopping one too quickly can raise the risk of having a seizure.

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