Anticonvulsants

Anticonvulsants, also known as anti-seizure medications, are primarily used to treat disorders like epilepsy, but many have been found to be effective in regulating the mood swings that come with bipolar disorder.

There are anticonvulsants that are considered as good as lithium, which is one of the oldest and most effective treatments for bipolar people. These anti-seizure medications can serve as a substitute treatment if lithium is not the drug best suited to a particular patient.

Some of these medications seem to have advantages over lithium, but, as with most drugs, there is the potential for side effects, some of them dangerous.

Anticonvulsants that are commonly used to stabilize moods include valproic acid (considered one of the most effective), carbamazepine, lamotrigine, topiramate, and gabapentin.

Where Anticonvulsants Fit In

Anticonvulsants can be effective mood stabilizers and may be used as a substitute for lithium when it is not an option.

How Anticonvulsants Work

Mood stabilizers work by affecting the nervous system and how it communicates. By stimulating or inhibiting particular aspects of the nervous system, a mood stabilizer can calm the swings between the manic and depressive phases of bipolar disorder, allowing for more normal function.

As with lithium, many anti-seizure medications must reach an optimal level in the system to be effective, though how quickly they reach that level varies. Valproic acid is believed to be able to do this faster than lithium. For many of these drugs, ensuring they reach and stay at safe and effective levels can require regular blood tests.

Who Can Take Anticonvulsants

These drugs are commonly prescribed for people who have bipolar disorder, but there are conditions your physician should be aware of before you start using this class of drugs.

Common conditions include, heart, kidney or liver disease; pregnancy or plans to become pregnant; breast-feeding mothers; cirrhosis of the liver, suicidal behavior or thoughts; and heart disease or irregularities.

Be sure to tell your doctor about any conditions you have to lessen chances of complications with your treatment.

Side Effects

Anticonvulsants can lead to specific, and oftentimes serious adverse effects. These are also, fortunately, among the more rare side effects.

These can include:

  • liver damage
  • ovarian cysts
  • kidney stones
  • drop in blood platelets (help the blood clot) or white blood cells
  • inflammation of the pancreas
  • potentially deadly skin rashes known as Stevens-Johnson Syndrome ( also called bullous erythema multiforme) and toxic epidermal necrolysis.

In 2009, the U.S. Food and Drug Administration also issued a warning indicating these drugs had been linked with an increased risk of suicidal activity.

Care must also be used when mixing these drugs with other treatments because they can potentially weaken or strengthen the effects of one another or cause other unwanted reactions.  

Other side effects of these drugs can include:

  • weight gain
  • weight loss
  • drowsiness
  • insomnia
  • loss of concentration
  • blurred vision
  • loss of coordination
  • tremors

Availability

Anticonvulsants are widely available and usually come in the form of capsules or tablets. There are liquid formulations and even some that come in granules that can be sprinkled into food.

These drugs can be found under the following brand names:

  • valproic acid: Depacon, Depakene, and Stavzor.
  • divalproex sodium (a variation of valproic acid): Depakote, Depakote ER, and Depakote  Sprinkles.
  • carbamazepine: Tegretol XR, Tegretol, Equetro, Epitol and Carbatrol.
  • lamotrigine: Lamictal , Lamictal Orange, Lamictal Blue and Lamictal Green.
  • topiramate: Topamax Sprinkle and Topamax
  • gabapentin: Neurontin and Gabarone .

Highlights

Anticonvulsants are an effective mood-stabilizing treatment for bipolar disorder.

Some are considered first-line treatments, or alternatives to lithium, the most widely used and effective treatment for bipolar.

There are potentially dangerous, though rare, side effects, including adverse influence on the liver, inflammation of the pancreas and possibly deadly skin rashes.

What The Expert Says

“...antiseizure meds can have serious toxic and liver effects, and difficulties if combined with other drugs, but can have fewer side effects in the long run,” said Dr, Soroya Bacchus, a psychiatrist practicing in Los Angeles.