Kevin Leehey, M.D.
1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835

MOOD STABILIZERS FOR BIPOLAR DISORDER (MANIC DEPRESSION)
Updated 11/12

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Group
Main Use
Medication
Brand/Generic
Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group
Mood stabilizers


(Bipolar, booster)
Eskalith CR 450
Lithobid
Lithonate
Lithotab
Lithium Carbonate
Li2 Co3
Capsules
Tablets
300mg
450mg
2 to 4 times a day Blood level
0.6-1.2
Lithium: nausea, GI irritation, diarrhea, vomiting, lower thyroid function, may increase white blood cells, tremor, skin rashes.

If dose too high side effects increase, may increase appetite.
Mood stabilizers are first choice for Bipolar Disorder (manic-depression). They are also used to boost the effects of antidepressants or help impulse control, violence.



Lithium is the best studied and may also treat unipolar depression. Slow release versions more convenient.



Tegretol, Topamax, Neurontin, Lamictal, Zonegran, and Depakote are also used for seizures.



Depakote may best help rapid cycling and mixed mania/depression. It also helps prevent migraines.



Tegretol XR, Carbatrol, and Equetro are all extended release form of carbamazepine.




Trileptal can be seen as a refined Tegretol without the many interactions or blood count risks. Thus, no regular blood tests.
Lithium has more nuisance side effects but usually  not serious except overdosage.


Depakote may rarely seriously harm the liver or pancreas or decrease platelets (clotting) and Tegretol may rarely seriously lower blood counts. Thus depending on which med labs are used we usually check such as blood level of medicine, thyroid, liver, blood count one or two times a year.



Depakote and Lithium may increase weight somewhat.



Interactions may be significant and varied with Tegretol.



All should be avoided if pregnancy, if possible.



Mood stabilizers offer little help for most anxiety unless as booster or part of Bipolar.





Hyponatremia (low sodium) risk is increased with Trileptal.
Depakote
valproic acid
Depakote ER
valproate
divalproex
Tablets
125mg
250mg
500mg
ER=Extended Release
250 mg
500mg
Sprinkles
(capsules)
125mg
2 to 3 times a day Blood level
50-125
Depakote: sedation (usually mild), may increase appetite, occassionally associated with mild to moderate hair loss. GI irritation. May increase energy.






Tegretol
carbamazepine





Carbatrol



Equetro





Trileptal
oxcarbazepine

Tablets
100mg (chewable)
200mg
XR (extended release)
100mg, 200mg, 400mg
suspension 100mg/5ml


Capsules
200mg, 300mg


Capsules
100, 200, 300mg


Scored tablets
150mg, 300mg, 600mg
suspension 300mg/5ml


2 to 3 times a day

XR one or 2 times a day






twice a day



twice a day





twice a day

 

Blood level
4-12







 


600-2400mg/day
no blood level

 

Tegretol: sedation, dizziness, nausea, double vision, unsteady gait if level high, usually mild insignificant drop in blood counts.






Similar to Tegretol without blood count risks and less interactions.

All these medications should be taken 7 days a week to be effective. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All antidepressants may increase mania risk in persons with Bipolar (manic-depressive) disorder. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.




Kevin Leehey, M.D. As of August 1, 2003: 1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835

MOOD STABILIZERS FOR BIPOLAR DISORDER (MANIC DEPRESSION) (Page 2)
Updated 11/12

Group
Main Use
Medication
Brand/Generic
Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group
(Continued)
Cautions for Group
(Continued)

Mood stabilizers
(Continued)


(Bipolar, booster)
Neurontin
(gabapentin)
 



Capsules
100mg
300mg
400mg
Tablets
600mg
800mg

 

 2 to 3 times a day
 800 to 2400mg
No blood level
Target 900 to 1800mg
Sedation (usually mild to moderate) dizzy, unsteady gait, fatigue.

Generics available.


Gabapentin and lamotrigine low in side effects, especially gabapentin which may also help sleep, anxiety, and pain. No lab tests needed. Gabapentin has very few, if any, significant interactions.


Lamotrigine and Lithium best treat Bipolar depressed phase. Lamotrigine may help non-Bipolar depression too.


All these may help migraines and nerve pain (gabapentin).

Topamax also may help decrease alcohol abuse.

Topamax and Zonegran may cause weight loss.

















Lamotrigine may cause a severe, dangerous rash, any age but especially in youth. Avoid with Depakote and increase dose slowly.





Topiramate rarely causes eye pain, glaucoma, osteoporosis, heat intolerance, or kidney stones, and may increase cleft lip or palate if taken while pregnant.

Lamictal
(lamotrigine) 
 Tablets
25, 100, 150, 200mg

XR Tablets
25, 50, 100, 200mg

 

 1 to 2 times a day
100-600mg
often 200-400mg
Blood level can be checked.
Nausea, dizzy, unsteady gait, double or blurry vision, headache, sedation. Rash, sometimes severe.
Topamax
(topiramate)
Tablets:
25mg
100mg
200mg
capsules (sprinkles):
15mg
25mg
2 times a day Up to
200-400mg
No blood level
Sedation, dizzy, unsteady gait, slower or fuzzy thinking, nervousness
Zonegran
(zonisamide)
Capsules:
25, 50, 100 mg
1 to 2 times a day 100-600mg per day Weight loss, agitation, anxiety, sedation, dizzy, ataxia, cognitive, rash, overheat (decrease sweat), insomnia Weight loss sometimes Little evidence as mood stabilizer.  Cousin of sulfa antibiotics so avoid if allergic to sulfa, Bactrim, Septra.  Rare kidney stones.

All these medications should be taken 7 days a week to be effective. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All antidepressants may increase mania risk in persons with Bipolar (manic-depressive) disorder. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.

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