Bipolar disorder is a serious mental illness that requires equally serious treatment. Medication is the first-line treatment with numerous medications available to treat bipolar disorder. Most people who have the disorder take a combination of drugs in order to achieve the best possible outcome. This process can take years. Even when optimal treatment is achieved, bipolar disorder symptoms can shift, causing a need for a shift in treatment as well. The most widely-used medications to prevent changes in mood in bipolar disorder are mood stabilizers.
Mood stabilizers are anticonvulsant medications. Since the modern use of lithium as a mood stabilizer, more mood stabilizing drugs have been used and developed to treat bipolar disorder. Part of the reason for this are the drawbacks and the risk of blood level toxicity that come with using lithium.
Mood stabilizers can be used during several shifts in mood in bipolar disorder including acute mania and depression. However, they are most common and effective in treating bipolar disorder as a prophylactic with half of patients using anticonvulsants as maintenance therapy. There are several different kinds of mood stabilizers professionals can choose from in order to achieve the best results for the patient in terms of effectiveness and absence of side effects.
Most common mood stabilizers:
- Carbamazepine (Tegretol)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Valproate (Depakote)
How they work:
Mood stabilizers increase the release of a neurotransmitter called GABA. GABA essentially calms the nervous system and may help to treat anxiety. They also control other transmitters like dopamine and noradrenalin, which are implicated in mania. Sodium channels are also inhibited, suppressing the release of the excitatory neurotransmitter glutamate and also limiting the reuptake of serotonin.
- For acute mania, results are inconsistent on efficacy, but some research indicates mood stabilizers such as carbamazepine and valproate may be as effective as lithium in treating acute mania.
- Carbamazepine is more effective than lithium in treating atypical manifestations of bipolar disorder such as rapid cycling and dysphoric mania.
- When used alone, mood stabilizers can decrease depressive symptoms by at least 50%.
- Unlike antidepressants, people who begin taking mood stabilizers are unlikely to experience a mood switch from depression to mania.
- Anticonvulsants seem to be at least as effective as antidepressants in treating bipolar depression.
- Lamotrigine may be the most effective mood stabilizer for treating depression as well as for depression prophylaxis.
- Remission rates are at least 50% more likely than those taking placebo.
Common side effects:
- Gastric distress
- Dry mouth
- Loss of balance
- Rash (sometimes life-threatening)
- Back pain
- Irregular periods
- Balance problems
- Muscle weakness
- Difficulty concentrating
- Mood swings
- Suicidal ideation
Always consult a physician before adding, discontinuing or changing any medication regimen. If you experience any side effects or signs of withdrawal, contact your doctor immediately.
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