Table of Contents
- Valproic acid (Depakene, generic), also called valproate, and its slower-dissolving form divalproex sodium (Depakote, generic)divalproex sodium, are approved for treatment of bipolar acute mania and mixed episodes.
- Lamotrigine ((Lamictal, generic) is approved for maintenance treatment of adults with bipolar I disorder. It is also used to treat bipolar depression.
- Carbamazepine (Epitol, Tegretol, generic), a standard alternative antiseizure drug used for mood stabilizing, is usually the second anti-seizure medication of choice.
- Other anti-seizure drugs used or investigated for bipolar disorder include gabapentin (Neurontin, generic), zonisamide (Zonegran, generic) and topiramate (Topamax, generic). To date, it is not clear if any of these newer drugs are useful for the treatment of acute mania.
General Side Effects. The side effects given here are associated with valproate. Other antiseizure drugs have similar effects and some specific ones of their own. Most are usually minor, occurring early in therapy and then subsiding. Valproate side effects may include:
- Gastrointestinal problems such as nausea, vomiting, and heartburn
- Headaches
- Visual disturbances
- Ringing in the ear
- Hair loss
- Weight gain (a significant problem with valproate)
- Agitation
- Odd movements
- Menstrual irregularities and a higher risk for polycystic ovary syndrome (PCOS)
- Birth defects when taken by pregnant women during the first trimester (valproate has the most evidence for causing birth defects)
- Cognitive impairment and symptoms of Parkinson's disease
Very serious side effects are possible. Antiseizure drugs can increase the risk for suicidal thoughts and behavior as soon as 1 week after starting drug therapy. The risk for suicidality can continue for at least 6 months. All patients who take these drugs should be monitored for worsening depression or unusual changes in behavior.
Stevens-Johnson syndrome (SJS) is a rare but severe and potentially life-threatening, rash that can develop as a side effect of carbamazepine, lamotrigine, oxcarbazepine and other anticonvulsants. Because this is a very serious condition, these drugs are discontinued at the first sign of rash. The risk of serious skin reactions is 10 times higher for patients of Asian ancestry than Caucasians. The FDA recommends that people of Asian ancestry get a genetic test before starting carbamazepine to determine if they are at risk for this side effect.
Other serious side effects, also rare, may include liver damage, aseptic meningitis (with lamotrigine), convulsions, coma, and pancreatitis.
[For more information on antiseizure drugs, see In-Depth Report #44: Epilepsy.]
Atypical Antipsychotics
Atypical antipsychotics are standard drugs for schizophrenia. They are also used to treat bipolar disorder alone or in combination with the mood stabilizers that treat mania.
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Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
