1980 E. Ft. Lowell Road, Suite 150 • Tucson, Arizona 85719 • (520) 296-4280 • Fax: (520) 296-3835
MOOD STABILIZERS FOR BIPOLAR DISORDER
(MANIC DEPRESSION)
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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. Lamotrigine and Lithium best treat Bipolar depressed phase. Lamotrigine may help non-Bipolar depression too. Other than the potential severe rash, lamotrigine has few side effects. no lab tests (EKG, etc.) are needed. All these may help migraines and nerve pain (gabapentin). |
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). Thus depending on which med is used we usually check blood level of medicine, thyroid, liver, blood count, etc one or two times a year. Depakote and Lithium may increase weight somewhat. All mood stabilizers should be avoided if pregnancy, if possible. Lamotrigine may cause a severe, dangerous rash, any age but especially in youth. Avoid with Depakote and increase dose slowly. |
| 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. |
|||
|
Lamictal |
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. |
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)
| 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, may also help sleep, anxiety, and pain, and decrease alcohol abuse. It also may help perimenopausal symptoms. No lab tests needed. Gabapentin has very few, if any, significant interactions. |
|
|
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
600-2400mg/day |
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.
|
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. |
Interactions
may be significant and varied with Tegretol. All mood stabilizers 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. Tegretol (carbamazepine) may rarely seriously lower blood counts. Thus periodic blood testing may be done. | |
| 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 |
Topamax also may help decrease alcohol
abuse. Topamax and Zonegran may cause weight loss.
|
Topiramate rarely causes eye pain, glaucoma, osteoporosis, heat intolerance, or kidney stones, and may increase cleft lip or palate if taken while pregnant. |
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.