Do not take any other medication that is not prescribed by your doctor e. Check with your pharmacist before deciding to take anything new.
All mood stabilizers should be taken regularly, preferably at around the same time every day. If you miss a dose do not double up, take your next dose at the regularly scheduled time. If you miss more than one dose please contact your doctor to discuss. Do not stop taking your mood stabilizers until you have spoken with your doctor to avoid any severe withdrawal effects.
If there is a need to stop taking the medication the dose should be gradually reduced. Text Size. In this section. Are you in crisis? Call the Fraser Health crisis line: or toll-free Trained volunteers provide emotional crisis support, 24 hours a day, 7 days a week. We will never share your email address with anyone. First Name. This post provides only general information about medications used for the treatment of bipolar disorder.
It does not cover all possible uses, actions, precautions, side effects, or interactions of the medicines mentioned. This information does not constitute medical advice or treatment and is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular medication.
The treating physician, relying on experience and knowledge of the patient, must determine dosages and the best treatment for the patient. In this closed group, you'll find encouragement and resources to help you keep your family strong and supported. Lithium : It is thought that lithium may affect the activity of two of these neurotransmitters, serotonin and dopamine. Anticonvulsants : These are believed to work by increasing the neurotransmitter, GABA, which has a calming effect on the brain.
It is also believed that they decrease glutamate, which is an excitatory neurotransmitter. Be Patient All mood stabilizing medications must be taken as prescribed. Drug Interactions Mood stabilizing medications can interact with other medications to create potentially serious health consequences. Side Effects Like all medications, mood stabilizing medications can have side effects. Get Educated Subscribe to receive a page educational pamphlet about bipolar disorder that covers prevalence, causes, course of illness, diagnosis, treatments, medication, and ways family members can help.
First Name Email Download. Read about other medications used to treat bipolar disorder. Valproate can also be used in combination with lithium if necessary. Some of the atypical antipsychotic medicines that are used to help control manic episodes have also proved effective at stabilising mood when taken in the long-term.
These include olanzapine, aripiprazole and quetiapine. How do they work? It is still fairly unclear how mood stabilisers work. Two neurotransmitters that are involved in regulating mood and behaviour are: serotonin dopamine.
Anticonvulsants like valproate are thought to work on the brain by: increasing the amount of a natural nerve-calming chemical called GABA reducing the amount of a natural nerve-exciting chemical called glutamate. Glutamate levels have been shown to be raised in the brains of people experiencing episodes of depression and mania. How long do they take to work? Lithium may take a week or more to begin working. Lithium Lithium is a naturally occurring element that is consumed in small amounts in the diet.
It is an effective drug, on average halving the risk of becoming unwell. Lithium is not as good in people with 'rapid cycling' bipolar disorder. Lithium is available as two salts: lithium citrate Priadel liquid lithium carbonate Camcolit , Liskonum , Priadel tablets. There are other issues to be aware of when taking lithium, including: the need for regular blood tests to monitor the level of lithium in your blood the importance of maintaining an adequate fluid intake and avoiding changes in your diet that suddenly increase or reduce your salt intake the potential problems of using certain other medicines at the same time.
Anticonvulsants Valproate The most commonly used anticonvulsant is valproate, either as valproate semi-sodium Depakote or sodium valproate eg Epilim , Epival CR , Episenta , Orlept. Carbamazepine Carbamazepine eg Carbagen SR , Tegretol , Tegretol retard was the first anticonvulsant to be discovered as an effective mood stabiliser as well as a treatment for epilepsy.
Other unlicensed anticonvulsants A number of anticonvulsants are now being used as mood stabilisers in bipolar disorder. Lamotrigine Lamictal has been shown to be effective in treating episodes of low mood in bipolar disorder and in preventing future episodes of low mood.
It has not currently been shown to be effective in preventing manic episodes. Its downside is that the dose needs to be increased slowly over a number of weeks to prevent a serious skin problem occurring, but this is usually not a problem. Others may find the side-effects distressing.
Side-effects usually lessen as treatment continues. Check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If side-effects are not mild and tolerable, let your doctor know as soon as possible.
Your doctor may:. With lithium, carbamazepine and divalproex, the dose is based on how much of the drug is in your blood and how you respond to treatment. This means that the dose differs for everyone who takes it. Blood samples are taken regularly to make sure that the dose is neither too high nor too low. Taking less may not be effective, and taking more can make you physically sick. The right dose is within a range, rather than a precise point.
It may change over time, depending on whether the medication is being used to treat active symptoms of mania or depression or to help prevent symptoms from returning. On days that you are scheduled to have your blood level tested, wait until after the test to take your morning dose to avoid inaccurate results. If you are taking carbamazepine, avoid grapefruit juice as it can raise the level of this drug in your body.
The oldest and most studied of mood stabilizers is lithium. However, many drugs that were first developed as anticonvulsants to treat epilepsy also act as mood stabilizers. These include carbamazepine, divalproex and lamotrigine. Gabapentin and topiramate are also anticonvulsants that may act as mood stabilizers, but they are usually given in addition to other medications.
Lithium Carbolith, Duralith, Lithane is found in nature in some mineral waters and is also present in small amounts in the human body. Common side-effects of lithium include increased thirst and urination, nausea, weight gain and a fine trembling of the hands.
Less common side-effects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes e. These effects are generally mild and fade as treatment continues.
If, however, any of these effects are severe, they should be reported to your doctor immediately. Thyroid and kidney function can be affected by lithium in some people and must be monitored regularly by your doctor.
Signs of lithium overdose: Lithium blood levels can increase to dangerous levels when a person becomes severely dehydrated. Severe vomiting, diarrhea or a fever can also cause dehydration. If you have these symptoms, stop taking lithium and see your doctor as soon as possible.
Changing the amount of salt you use can also affect lithium levels: avoid switching to low- or no-salt diets. Signs that the amount of lithium in the body is higher than it should be include severe nausea, vomiting and diarrhea, shaking and twitching, loss of balance, slurred speech, double vision and weakness. If you experience any of these effects, see your doctor as soon as possible. In the meantime, stop taking lithium and drink plenty of fluids.
If you cannot reach your doctor and the symptoms do not clear up, go to the nearest hospital emergency department. The differing names for this anticonvulsant medication reflect the various ways it is formulated.
Divalproex and its various forms is used for acute manic episodes. Brand names include Depakene and Epival. Common side-effects of divalproex include drowsiness, dizziness, nausea and blurred vision.
Less common side-effects are vomiting or mild cramps, muscle tremor, mild hair loss, weight gain, bruising or bleeding, liver problems and, for women, changes in the menstrual cycle. Carbamazepine Tegretol is another anticonvulsant. It is used for mania and mixed states that do not respond to lithium or when the person is irritable or aggressive. Common side-effects of carbamazepine include dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes, and poor co-ordination.
A rare but dangerous side-effect of carbamazepine is reduced blood cell counts. People who take this drug should have their blood monitored regularly for this effect. Soreness of the mouth, gums or throat, mouth ulcers or sores, and fever or flu-like symptoms can be a sign of this effect and should be reported immediately to your doctor.
If carbamazepine is the cause of these symptoms, they will go away when the medication is stopped. Oxcarbazepine Trileptal , a closely related drug, may have less side-effects and drug interactions than carbamazepine, but is not as well studied for bipolar disorder. Lamotrigine Lamictal may be the most effective mood stabilizer for depression in bipolar disorder, but is not as helpful for mania. The starting dose of lamotrigine should be very low and increased very slowly over four weeks or more.
This approach decreases the risk of a severe rash—a potentially dangerous side-effect of this drug. Common side-effects of lamotrigine include fever, dizziness, drowsiness, blurred vision, nausea, vomiting or mild cramps, headache and skin rash.
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