Anticonvulsants for Bipolar Disorder

It is not known exactly how these medications work. However, it is thought that anticonvulsant medications slow down abnormal electrical discharges in the brain. These abnormal discharges are linked to seizures and an imbalance of brain chemicals (neurotransmitters), which can cause mania in bipolar disorder.

Valproate Sodium (Depakene Syrup) and Divalproex Sodium (Depakote)

Valproate Sodium (Depakene Syrup) and Divalproex Sodium (Depakote) have been approved as treatments for acute manic episodes in bipolar disorder.

Valproate will most often be taken along with a mood stabilizer (such as lithium carbonate or antidepressants) to avoid moving the person into a depressive episode. Valproate is also used during manic episodes for people who do not respond well to mood stabilizer treatment (such as lithium carbonate) alone.

Valproate has been known to work in the treatment of mania when other treatment options (such as mood stabilizers) have failed. Valproate is not as effective at treating the depression episodes of bipolar disorder.

Side effects of Valproate can include:

• Drowsiness
• Low energy
• Weight gain
• Temporary hair loss
• Headaches, and confusion

A new warning label has recently been added to valproate injections and divalproex tablets/capsules that warns there may be an increase in pancreatitis associated with the use of these products.

Lamotrigine (Lamictal)

Lamotrigine (Lamictal) has not yet been formally approved to treat bipolar disorder; however, it may commonly be prescribed. In initial research studies, lamotrigine was well tolerated by people and was very effective at treating both depression and mania associated with bipolar disorder.

Lamotrigine has been known to improve mood, alertness, and the way a person relates to other people. Lamotrigine is taken alone without other medications normally used to treat bipolar disorder. Research is continuing into the treatment of bipolar disorder with this medication, and further information will be available soon.

Side effects of Lamotrigine can include:

• Headaches
• Sleepiness
• Weight gain
• Minor skin rashes that developed when the medication was stopped
• Toxic rashes
• Dizziness and blurred vision
• Nausea and vomiting
• Liver function problems
• Life-threatening allergic reaction

Other things to be aware of when evaluating these medications.

• You will want to consider the side effects of these medications and the possible negative interactions with other medications you may be taking before trying either valproate or lamotrigine.
• If you have had difficulty controlling episodes of mania, valproate may be a good medication choice for you. Valproate (can act as a mood stablizer) instead of other mood stabilizers (such as lithium).
• Valproate may also be prescribed in addition to other medications (for example, an antipsychotic such as risperidone) to control your bipolar disorder.
• If you have been taking antidepressants but have not been able to control your mood episodes of depression or mania lamotrigine may be an option to try to treat your bipolar disorder.

Making the decision about which medications to use can be a very complicated issue in the treatment of bipolar disorder. You may have to try several medications or combinations of medications before finding what works best for you. Always discuss all the options and side effects with your doctor.