In recent years, several anticonvulsant medications have become recognized as mood stabilizers to treat or prevent mood episodes in bipolar disorder. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. 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.
There's no denying the exhilaration that mania brings. For many with bipolar
disorder, there's a period of denial -- a disbelief that the wonderful surge of
energy and euphoria marks a disease that truly needs treatment.
"Mania is a fascinating thing ... it's the brain creating its own
hormonal high," says Carrie Bearden, PhD, a clinical neuropsychologist and
assistant professor of psychiatry at UCLA. "Most people first become manic
in their early 20s, at a time in life when they're not thinking...
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), while Depakote and Tegretol are more established acute than preventative treatments. Other anticonvulsants are less established for treating mood symptoms in bipolar disorder, but some are also used "off label" for other types of problems such as anxiety (e.g. Neurontin or Lyrica), or weight loss (e.g. Topamax).
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 closely.
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."