Bipolar Treatment With Mood Stabilizers

Bipolar disorder is often treated with what are called mood stabilizers, which include lithium, valproate (Depakote), or carbamazepine (Tegretol). These medications can be very effective in treating hypomania or mania and preventing the recurrence of bipolar episodes.
Bipolar Treatment: Types of Mood Stabilizers
Bipolar disorder is different in different people. A treatment that can help someone else may not work for you, and vice versa. However, mood-stabilizing medications that your doctor may recommend include:

• Lithium. Lithium can help balance out the emotional highs and lows of bipolar disorder. "Lithium has this curious property of working both against mania and depression," says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston and associate professor of psychiatry at Harvard Medical School. Lithium works by helping to normalize brain activity.
• Valproate and carbamazepine. Valproate (also called valproic acid) and carbamazepine were first used to treat convulsions in people with epilepsy. Researchers then found that these drugs could also help treat symptoms of bipolar disorder. "Valproic acid and carbamazepine have, in fact, been shown to work for mania," says Dr. Sachs. These medications can help with bipolar episodes, especially the rapid-cycling variety in which moods change from mania to depression and back again over a period of hours or days. Sachs says there is also ample evidence supporting the use of valproate to help prevent recurrences of bipolar episodes. Valproate and carbamazepine work by calming the brain, resulting in a better and more stable mood.
• Combination of medications. Lithium, valproate, and carbamazepine are often used together for a more potent mood-stabilizing effect in bipolar treatment.

Bipolar Treatment: Special Considerations
Lithium is usually preferred for the treatment of bipolar disorder in children and adolescents, since the safety of valproate and carbamazepine is still being evaluated in these groups. Some research has suggested that valproate may put girls and women at risk of hormonal abnormalities and polycystic ovary syndrome when the medication is taken before age 20.
In addition, women will need to talk with their physician about what medications are safe to take if they are trying to conceive, are pregnant, or are nursing. There is a risk that bipolar medications could harm a developing fetus or nursing baby, but your doctor may be able to tell you about new bipolar treatments that are thought to be safer during pregnancy and lactation.
Bipolar Treatment: Side Effects of Mood Stabilizers
Depending on the medication you are using, your doctor or pharmacist can tell you about side effects you could experience. In general, lithium may be associated with:

• Drowsiness
• Weakness
• Nausea
• Fatigue
• Tremor
• Thirst
• Frequent urination
• Weight gain
• Thyroid problems

Side effects of valproate and carbamazepine may include:

• Gastrointestinal problems
• Headache
• Double vision
• Dizziness
• Anxiety
• Confusion
• Liver problems

Any doctor can prescribe these medications, but it is a good idea to see a psychiatrist who trained to deal with bipolar disorder and other mental illnesses. You will probably take these medications over the long term, and you may need to add medications if you have manic or depressive episodes that break through despite the treatment. People with bipolar disorder usually need more than one medication. Your psychiatrist can work with you to find the best bipolar treatment regimen.