Mood Stabilizers - The Anticonvulsants

Patient Expert

Last month I wrote a series about Lithium, which was the first medication discovered to act as a mood stabilizer in patients with bipolar disorder. In addition, other drugs not originally developed to treat bipolar disorder have shown mood stabilizing effects.

Many other mood stabilizers are classed as anticonvulsants - medications that treat seizure disorders, also known as anti-epileptic drugs (AEDs). There are some AEDs that haven't been shown to be effective mood stabilizers (including Dilantin, Zonegran, phenobarbitol and others), but about half of them are prescribed for bipolar disorder.

As is often the case, the effectiveness of AEDs as mood stabilizers was discovered by accident when doctors noticed mood improvements in people taking AEDs for epilepsy.

Some of those are specifically approved by the FDA for use in treating bipolar disorder, while others are prescribed "off-label," which means doctors use them even though they aren't approved for bipolar (which is perfectly legal).

The AEDs approved as mood stabilizers by the FDA are:

  • Depakote (valproate)
  • Equetro (carbamazepine)
  • Lamictal (lamotrigine)

Other AEDs routinely used off-label as mood stabilizers include:

  • Tegretol (note: Tegretol XR is exactly the same as Equetro)
  • Topamax (topiramate)
  • Trileptal (oxcarbazepine)
  • Klonopin (clonazepam, which is primarily classed as an anti-anxiety drug)
  • Neurontin (gabapentin)

Some studies have shown the latter drugs aren't particularly effective for bipolar disorder. In fact, the makers of Neurontin got into a lot of trouble because their representatives were marketing the drug as a mood stabilizer when it wasn't FDA approved. Basically, doctors can prescribe drugs for unapproved uses, but drug companies can't market them for those uses.

But it's important to understand that even if the clinical information just isn't there for the second group of medications, they do help some people - and you might be one of them.

As a group, anticonvulsants all carry a risk of birth defects - some more than others. Equetro/Tegretol, Trileptal and Depakote have a particularly high incidence of causing serious birth defects.

The most common side effects of AEDs include nausea, irritability, drowsiness, coordination problems and skin rash (particularly dangerous with Lamictal). Report fever, mouth sores, easy bruising or sore throat to your doctor, as these can indicate more serious side effects.