Anticonvulsants for Mania in Bipolar Disorder

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Convulsions are not part of bipolar disorder—so why would anticonvulsants be prescribed to manage mood? Anticonvulsants in the treatment of mania were introduced when their therapeutic value was noted through improved mood stability of those with epilepsy.

Initially, they were used for those who were resistant to Lithium treatment. They are now an important alternative both on their own and with other medications.

Pros and Cons of Anticonvulsants

Different anticonvulsants seem to treat different aspects of bipolar disorder:

  • Some, like Depakote and Tegretol, are particularly effective at treating mania.
  • Others, like Lamictal, are more effective at treating depression.
  • Still, others may be less effective at treating immediate symptoms, but do a good job of helping to stabilize mood and thus help to avoid manic or depressive episodes.

As with most drugs used to treat bipolar disorder, anticonvulsants do have significant side effects that vary from person to person. For example, most can cause dizziness and drowsiness, headaches, dry mouth, etc. In many cases, though, side effects can lessen over time as your body becomes more accustomed to the medication.

There are also more serious side effects that can occur with long-term use of anticonvulsants. For example, pregnant women should avoid anticonvulsants, as they can cause birth defects. Some can cause kidney or liver damage if not carefully monitored.

It's also important to know that anticonvulsants can interfere with other medications, so you should let your doctor know about any new medications you've been prescribed or are taking over-the-counter.

Despite all the problems associated with anticonvulsants, in some cases, they are more effective—and less problematic—than classic treatments. Both anticonvulsants and lithium, for example, take several weeks to reach peak effectiveness, but anticonvulsants usually act more rapidly than lithium.

For some people, for whom lithium is less effective or less well tolerated, anticonvulsants can be a good option. Because there are so many different anticonvulsants, each of which works a little differently, it is possible to try more than one to find the best choice for your particular needs.

Some Commonly Prescribed Anticonvulsants

The following is a list of some of the anticonvulsants most commonly prescribed for bipolar disorder:

Valproate (Depakote)

In 1995, this drug became the first anticonvulsant approved by the FDA for the treatment of mania. It is often used as a first-line treatment for those who rapid cycle.

Carbamazepine (Tegretol)

Tegretol was approved in 2004 to treat mania and mixed episodes. Often, individuals find the side effects of this drug too difficult to tolerate.

Lamotrigine (Lamictal)

Lamictal was approved in 2003 for bipolar disorder in patients 18 years and older for maintenance treatment.

Topiramate (Topamax)

Topiramate in the newest anticonvulsant on the scene. It is also an adjunctive therapy. It seems to create some difficulties with cognitive functioning but has the benefit of often encouraging weight loss.

Trileptal (Oxcarbazepine)

Trileptal (oxcarbazepine), which is FDA-approved to treat partial seizures in adults and children, is sometimes prescribed off-label to treat bipolar disorder.

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.