A brief overview of the most commonly prescribed mood stabilizers, with generic and brand names, indications, and side-effects.
The following medicines are prescribed for the treatment of Bipolar disorder. This is a general outline of some of the most common ones, their side effects, and special considerations which your doctor will discuss with you.
Lithium (brand names Lithobid, Eskalith). By far the most effective treatment for bipolar disorder, Lithium is also the oldest. A psychiatrist treating a newly diagnosed patient will usually begin with Lithium, unless there are liver problems or other medical conditions which make it difficult to metabolize the drug. Side-effects can include nausea, vomiting, and indigestion. As with all of these medications (including the anti-seizure agents) Lithium is effective only if a certain amount of it is present in the bloodstream. Your doctor will want to take blood samples periodically during your treatment to check whether the amount present falls within the "therapeutic range".
Divalproex (brand name Depakote) works similarly to Lithium, and is sometimes prescribed if treatment with Lithium has failed. Like all medications discussed here, it has anticonvulsant properties, and can also be used to treat seizure disorders. Side-effects can include nausea, indigestion, and dizziness or drowsiness. Your doctor will take a complete medical history before prescribing this medication, and observe you closely for any problems.
In addition to treating Bipolar disorder, Lithium and Valproex can also be used in combination with antidepressants to strengthen or augment their effects.
The above two drugs are the main ones used to treat Bipolar disorder. However, a number of medications which were originally developed to control seizure disorders have also been shown to work. Psychiatrists often recommend such "off-label" prescriptions, especially for patients who have tried Lithium or Divalproex without success. Your doctor will ask you about any history of liver problems, blood disorders, or heart problems before he begins any of these; if he's not sure, he may order a liver function or a blood test. Also, since the medicines can cause sleepiness, your doctor may also want to observe your response to these drugs before you drive a car or operate machinery. As with Lithium and Divalproex, a therapeutic range needs to be maintained and monitored with occasional blood tests when using many of these.
Carbamazepine (Epitol, Tegretol) has been shown to be effective in treating Bipolar disorder, but tolerance may develop--you may need increasing amounts of the medicine to get the desired effect. Although rare, side effects can include bone marrow problems, heart problems, and eye problems.
Lamotrigine (Lamictal) has similar properties. Though it can reduce symptoms, potential side effects include nausea, vomiting, drowsiness, a skin rash or, more rarely, Stevens-Johnson Syndrome, an acute allergic reaction.
Gabapentin (Neurontin) was found in 1996 to be effective in managing symptoms of Bipolar disorder, and is commonly prescribed for patients who don't respond to Lithium or Depakote. It's important to drink plenty of water when taking this drug. Your doctor will also want to know about any kidney problems.
Topiramate (Topamax), like Gabapentin, is excreted through the kidneys, and so hydration is important. Side-effects can include dizziness or drowsiness, fatigue, and loss of appetite.