Mood Stabilizers for the treatment of Bipolar Disorder (Manic Depression)

Medications used to treat Bipolar Disorder are usually known as mood stabilizers. These medications can be used alone but are often used in combination with anti psychotic medications, antidepressants and anti anxiety medications. Some medications used in the treatment of Bipolar disorder are anticonvulsants which are usually used to treat epilepsy, but have been found to be also valuable to treat mood disorders.

All of these medications require regular blood testing but for different reasons and at different intervals.

It is very important to let your prescribing doctor know if you are taking any other medications due to their particular interactions with a number of other medications.

1. Lithium Carbonate

This medication has been used for a long time both as an initial treatment for Bipolar disorder and as an ongoing treatment to prevent the re-occurrence of symptoms. It has both an anti-manic and anti-depressant effect. It works by exciting an effect on the chemicals in the brain called neurotransmitters.

Lithium should always be taken with meals to avoid feeling nauseous. Lithium needs to be taken at regular intervals throughout the day to keep blood levels at a steady level. Blood levels are taken at regular intervals to determine the correct dose. Reaching a therapeutic dose is particularly important with this medication. There are a number of things that effect blood levels including:-

  • dieting, particularly low salt diets
  • diuretic medications
  • excessive sweating due to hot weather or illness
  • inadequate or too much fluid intake
  • missed doses. Do not attempt to make up for missed doses as this could push the blood levels too high.
  • vomiting and diarrhoea (NOTE.. this could also be a sign of too much lithium)

Side Effects of Lithium

All medications can cause side effects. Some such as fine tremor of the hands, mild nausea, increased thirst and increased urination can occur particularly when first starting on this medication.

Other side effects include diarrhea, vomiting, worsening of hand tremor, drowsiness, slurred speech, difficulty with coordination, ringing in the ears, dizziness and confusion. These medications should be reported immediately as they might indicate too high a dose requiring immediate adjustment.

2. Carbamazepine (Tegretol)

This medication is also used in the treatment of epilepsy. It is important to note that the enzymes that break down Carbamazepine (Tegretol) can increase or decrease the effects of other drugs and in some cases can counteract their effect. This is why your doctor needs to know what other medications you are taking. It acts by limiting the activity at the synapse. These are precise areas in the brain where messages are transmitted. This produces a calming effect on both the physical and feeling states of the person. It has a sedative, muscle relaxant and mood stabilizer.

To achieve the desired effect, carbamazepine is always taken in combination with other medications including anti psychotics or antidepressants. Blood tests are taken at intervals but not as regularly as lithium, to monitor and achieve the appropriate dose.

It is best to take carbamazepine with food to avoid gastric irritation.

Side Effects of Carbamazepine

Should side effects occur they tend to present early in treatment. The most frequently reported are nausea, abdominal pain, indigestion and dry mouth. Any side effects should be reported to your doctor as a change in dose many be indicated.

3. Sodium Valproate (Epilim or Valpro)

Most commonly used in epilepsy. It’s action is not clear but is thought to increase the concentration of the inhibitory neuro transmitters in the brain. (GABA). It is often used in Rapid Cycling Disorder where moods swing quickly and frequently between feeling high and depressed. Sodium Valproate can be used alone or in combination with other medications including anti psychotics and anti depressants. It is particularly important with this medication to let your doctor know of any other medications you are taking because of Sodium Valproate’s effect on other medications. Blood tests are taken to determine therapeutic levels and to review dosage. Take with meals to avoid gastric irritation.

Side Effects of Sodium Valproate

If side effects occur they are usually early in treatment and are often transient. These include nausea, indigestion, sedation, drowsiness, vomiting and excess saliva. Any side effects should be reported to your doctor as a change in dose may be indicated.

See the sheet “Medication in the Treatment of Psychosis and Schizophrenia”

General Information

It is always best to avoid alcohol and marijuana while taking medications as you will get affected more quickly. You may become dizzy and risk injury by falling. Your judgement will also be affected. Alcohol increases the effect of the medication and the medication increases the effect of the alcohol. Be aware of potential side effects that may affect your ability to drive a motor vehicle or handle machinery including power tools.

Take time to allow your medication to work. It takes time for an illness to develop and takes time for the medication to take effect.