Mood Stabilizers for Bipolar Disorder

Mood stabilizers are usually the first choice to treat bipolar disorder. Except for lithium, many of these medications are anticonvulsants. They’re usually used to treat seizures, but they also help control mood. Research has found that mood stabilizers are effective for treating the symptoms of bipolar disorder, but it is not clear exactly how they work. Brain chemicals called neurotransmitters (chemical messengers) are believed to regulate mood.

• Lithium: It is thought that lithium may affect the activity of two of these neurotransmitters, serotonin and dopamine.
• Anticonvulsants: These are believed to work by increasing the neurotransmitter, GABA, which has a calming effect on the brain. It is also believed that they decrease glutamate, which is an excitatory neurotransmitter.

Be Patient

All mood stabilizing medications must be taken as prescribed. After achieving the desired, effective dose of a mood stabilizer, it may take an additional 1-2 weeks before you can expect to see improvement in manic symptoms. It may take up to 4 weeks for depressive symptoms to lessen.

It is important that you don’t stop taking your medication because you think it’s not working. Give it time!

Keep Working to Find the Right Fit

You and your doctor have a lot of choices of medications. It’s hard to know which one may work best for you. Sometimes the mood stabilizing medication you first try may not lead to improvements in symptoms. This is because each person’s brain chemistry is unique; what works well for one person may not do as well for another. Be open to trying a different medication or combination of medications in order to find a good fit. Let your doctor know if your symptoms have not improved or have worsened, and don’t give up searching for the right medication!

Prevent Relapse: Don’t Stop!

Once you have responded to medication treatment, it is important to continue taking your medication as prescribed. In general, it is necessary for individuals with bipolar disorder to continue taking mood stabilizing medications for extended periods of time (at least 2 years).

Discontinuing treatment earlier may lead to a relapse of symptoms. If you have had a number of episodes of mania or depression, your doctor may recommend longer-term treatment. If episodes of mania or depression occur while on mood stabilizers, your doctor may add other medications to be taken for shorter periods of time.

To prevent symptoms from returning or worsening, do not abruptly stop taking your medications, even if you are feeling better, as this may result in a relapse. You should only stop taking your medication under your doctor’s supervision. If you want to stop taking your medication, talk to your doctor about how to correctly stop.

Drug Interactions

Mood stabilizing medications can interact with other medications to create potentially serious health consequences. Be sure to tell your doctor about all the medications you are taking, including prescription medications, over-the-counter medications, herbal supplements, vitamins, and minerals.

Side Effects

Like all medications, mood stabilizing medications can have side effects. In many cases, these side effects are mild and tend to diminish with time. Many people have few or no side effects, and the side effects people typically experience are tolerable and subside within a few days. Your doctor will discuss some common side effects with you. Check with your doctor if any of the common side effects persist or become bothersome. If you experience side effects, talk to your doctor before making any decisions about discontinuing treatment.

In rare cases, these medications can cause severe side effects. Contact your doctor immediately if you experience one or more severe symptoms.

Mood Stabilizing Medications

• Lithium (Eskalith or Lithobid)
• Valproate/Valproic Acid/Divalproex Sodium (Depakote or Depakene)
• Carbamazepine (Equetro or Tegretol)
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trileptal)
• Gabapentin (Fanatrex, Gabarone, Horizant, or Neurontin)
• Topiramate (Topamax or Topiragen)
• Oxcarbazepine (Trileptal)

Side Effects of Mood Stabilizers

Lithium
Common side effects of lithium: acne; fine hand tremor; increased thirst; nausea; low thyroid hormone (associated with brittle hair, low energy, and sensitivity to cold temperatures); rash; weight gain.

Lithium toxicity is a serious condition caused by having too much lithium in your system. For this reason, your doctor will require you to do periodic blood tests to ensure that lithium is not impacting your kidney or thyroid functioning. In addition, use of certain pain medications (such as ibuprofen) or physical activity with significant sweating can cause your lithium level to increase. You should talk to your doctor about how to exercise safely. Some signs of lithium toxicity include new onset of nausea, vomiting, diarrhea, headache, loss of coordination, slurred speech, nystagmus (abnormal eye movements), dizziness, seizure, confusion, increased thirst, and worsening tremors. You should contact your doctor right away if you experience any of these symptoms.

Anticonvulsants
Common side effects of anticonvulsants: appetite change; dizziness; double vision; headache; irritability; loss of balance/coordination; nausea; sedation; vomiting; weight gain or loss.

Lamotrigine and Carbamazepine may affect white blood cells, the liver, and other organs. Individuals prescribed these medications will need to have their blood checked periodically to make sure the medications are not impacting their organs in a negative way.

Lamotrigine and Carbamazepine can also cause a serious skin rash that should be reported to your doctor immediately. In some cases, this rash can cause permanent disability or be life threatening. The risk for getting this rash can be minimized by very slowly increasing your dose of Lamotrigine. This rash occurs to a lesser extent with Carbamazepine although the risk is higher for individuals of Asian ancestry, including South Asian Indians.

Anticonvulsant medications may increase suicidal thinking and behaviors. Close monitoring for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior is advised.

Here are some additional articles you might find helpful:

• What Causes Bipolar Disorder
• Bipolar Disorder: The Symptoms
• Evidence-Based Treatments for Bipolar Disorder 
• Bipolar Disorder Medication: What You Should Know
• Antipsychotic Medication for Bipolar Disorder: What You Should Know
• Antidepressants for Bipolar Disorder: What You Should Know