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.
Rapid cycling is a pattern of frequent, distinct episodes in bipolar disorder. In rapid cycling, a person with the disorder experiences four or more episodes of mania or depression in one year. It can occur at any point in the course of bipolar disorder, and can come and go over many years depending on how well the illness is treated; it is not necessarily a "permanent" or indefinite pattern of episodes.
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 Neurontin, Lyrica, or Topamax -- are also used "off label" for other types of problems such as 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 include:
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 they 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.
WebMD Medical Reference: "Bipolar Disorder (Manic Depressive Disorder)."
WebMD Assess Plus: Bipolar Disorder Assessment.
National Institute for Mental Health: "Step-BD Womens Studies."
Massachusetts General Hospital Bipolar Clinic & Research Program.
MedicineNet.com: "Bipolar Disorder (Mania)."
WebMD Medical Reference: "Effects of Untreated Depression."
American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."
Joseph Goldberg, MD on September 11, 2014