Which medications in the drug class Anticonvulsants are used in the treatment of Bipolar Disorder?

Updated: May 30, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Anticonvulsants

Anticonvulsants have been effective in preventing mood swings associated with bipolar disorder, especially in those patients known as rapid cyclers. For the depressed phase, mood stabilizers, such as lithium and lamotrigine, are preferred, because antidepressants may propel a patient into a manic episode or exacerbate irritability in mixed-symptom mania. Gabapentin, although not a mood stabilizer, also may have anxiolytic properties.The most widely used anticonvulsants have been carbamazepine, valproate, and lamotrigine. More recently, topiramate and oxcarbazepine also are being tried.

Note that the Department of Veterans Affairs/Department of Defense (VA/DoD) do not recommend lamotrigine, topiramate, and gabapentin in patients with mania or mixed episodes. [3]

Carbamazepine (Equetro, Epitol, Carbatrol, Tegretol, Tegretol XR)

Carbamazepine is effective in patients who have not had a clinical response to lithium therapy and who have rapid-cycling bipolar disorder. Its efficacy is not well established for long-term use; therefore, periodically reevaluate the long-term risks and benefits of carbamazepine for individual patients. This drug can also act to inhibit seizures induced through the kindling effect, which is thought to occur by way of repeated limbic stimulation.

Valproate sodium, valproic acid, divalproex sodium (Depakene, Depakote, Depakote ER, Depacon, Stavzor)

Valproate has proven effectiveness in treating and preventing mania. It is classified as a mood stabilizer and can be used alone or in combination with lithium. This agent is useful in treating patients with rapid-cycling bipolar disorders and has been used to treat aggressive or behavioral disorders. A combination of valproic acid and valproate has been effective in treating persons in manic phase, with a success rate of 49%.

Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)

Lamotrigine is an anticonvulsant that appears to be effective in the treatment of the depressed phase in bipolar disorders. It is used for the maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in adults treated for acute mood episodes with standard therapy.

Topiramate (Topamax, Qudexy XR, Trokendi XR, Topamax Sprinkle)

Topiramate has an off-label indication for the treatment of bipolar disease. In a small retrospective review, marked improvement occurred in 62% of patients when topiramate was added to their current regimen. [115] . It is unclear if topiramate's efficacy occurs only as adjunctive treatment. More studies are needed to examine potential benefits of this drug in treating bipolar disorders. Unlike conventional neuroleptics, topiramate is not associated with weight gain.


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