Mood Stabilizers for Bipolar Disorder (Manic Depressive)

Kevin Leehey, M.D.
1200 North El Dorado Place
Building H, Suite 800
Tucson, AZ 85715
(520) 296-4280

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 and Depakote are also used for seizures.

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

Neurontin, Topamax, and Lamictal are new and seem low in side effects, especially Neurontin which may also help sleep and pain. No lab tests needed. Topamax may cause weight loss. Litium has more nuisance side effects but not serious usually except overdosage.

Depakote may rarely seriously harm the liver and Tegretol may rarely seriously lower blood counts. Thus depending on which med labs are usually important to check such as blood level of medicine, thyroid, liver, blood count.

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

Lamictal may cause a severe, dangerous rash, especially in youth. Avoid with Depakote and increase dose slowly.

Depakote
Valproic Acid Tablets
125mg
250mg
500mg 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 Tablets
100mg (chewable)
200mg
XR (extended release)
100mg
200mg
400mg
suspension 100mg/5ml 2 to 3 times a day

XR one or 2 times a day Blood level
4-12 Tegretol: like TCA (see TCA), unsteady gait if level high, usually mild insignificant drop in blood counts.

Neurontin
Gabapentin
Capsules
100mg
300mg
400mg

2 to 3 times a day
800 to 2400mg
No blood level
Target 900 to 1800mg
in adults often

Sedation (usually mild to moderate) dizzy, unsteady gait, fatigue.

Lamictal
Lamotrigine
Tablets
25mg
100mg
150mg
200mg

1 to 2 times a day
No blood level

Nausea, dizzy, unsteady gait, double or blurry vision, headache, sedation.

Topamax
Topiramate Tablets:
25mg
100mg
150mg
200mg
capsules (sprinkles):
15mg
25mg
2 times a day Often
200-400mg
No blood level
Sedation, dizzy, unsteady gait, slower or fuzzy thinking, nervousness

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.

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 and Depakote are also used for seizures. Depakote may best help rapid cycling and mixed mania/depression. It may also help prevent migraines. Neurontin, Topamax, and Lamictal are new and seem low in side effects, especially Neurontin which may also help sleep and pain. No lab tests needed. Topamax may cause weight loss.	Litium has more nuisance side effects but not serious usually except overdosage. Depakote may rarely seriously harm the liver and Tegretol may rarely seriously lower blood counts. Thus depending on which med labs are usually important to check such as blood level of medicine, thyroid, liver, blood count. 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 little help for most anxiety unless as booster or part of Bipolar. Lamictal may cause a severe, dangerous rash, especially in youth. Avoid with Depakote and increase dose slowly.
	Depakote Valproic Acid	Tablets 125mg 250mg 500mg	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	Tablets 100mg (chewable) 200mg XR (extended release) 100mg 200mg 400mg suspension 100mg/5ml	2 to 3 times a day XR one or 2 times a day	Blood level 4-12	Tegretol: like TCA (see TCA), unsteady gait if level high, usually mild insignificant drop in blood counts.
	Neurontin Gabapentin	Capsules 100mg 300mg 400mg	2 to 3 times a day	800 to 2400mg No blood level Target 900 to 1800mg in adults often	Sedation (usually mild to moderate) dizzy, unsteady gait, fatigue.
	Lamictal Lamotrigine	Tablets 25mg 100mg 150mg 200mg	1 to 2 times a day	No blood level	Nausea, dizzy, unsteady gait, double or blurry vision, headache, sedation.
	Topamax Topiramate	Tablets: 25mg 100mg 150mg 200mg capsules (sprinkles): 15mg 25mg	2 times a day	Often 200-400mg No blood level	Sedation, dizzy, unsteady gait, slower or fuzzy thinking, nervousness