In addition to lithium, other mood stabilizers used in the treatment of bipolar disorder include anticonvulsants. They may be combined with lithium or with each other for maximum effect. Specific ones used for bipolar syndrome include:
Anticonvulsants. Antiseizure medications (also called anticonvulsants) such as valproic acid (Depakene) and divalproex (Depakote) can have a mood-stabilizing effect in people with bipolar disorder. There is some evidence that valproic acid may result in hormonal changes in teenage girls and polycystic ovarian syndrome (PCOS) in women who began taking the medication before age 20. Young women should discuss this risk with their health care professionals, and those taking valproic acid should be monitored carefully for possible hormonal problems.The anticonvulsants carbamazepine (Tegretol) and oxcarbazepine (Trileptal) also have some effects as mood stabilizers, although they are not yet approved for bipolar disorder by the U.S. Food and Drug Administration (FDA). At this point, there is more evidence on the effectiveness of Tegretol than Trileptal.And the anticonvulsant lamotrigine (Lamictal) is FDA-approved for the long-term treatment of adults with bipolar disorder. It is specifically used to treat the depressive episodes involved with bipolar disorder.Some anticonvulsants can decrease the effectiveness of hormonal contraceptives, such as birth control pills. It is important to discuss your method of contraception with your health care provider to determine if there is an interaction.
Severely ill patients may require a combination treatment with mood stabilizers and other drugs, including:
Antidepressant medications. Several classes of antidepressant medications are sometimes used to treat the depressive symptoms of bipolar disorder, including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin). However, the use of antidepressants in people with bipolar disorder is controversial, since antidepressants may not be any more effective than mood stabilizers at treating depressive episodes in people with bipolar disorder and can trigger manic episodes. Make sure you tell your health care professional about any prior symptoms of hypomania or mania (episodes that include increased energy, euphoria and irritability) before beginning antidepressants.Side effects and effectiveness differ for each class of antidepressant, as well as for the individual brands. Antipsychotics. If you’re experiencing psychotic or manic symptoms during an episode of bipolar disorder, health care practitioners will sometimes prescribe antipsychotic medicine alone or in combination with a traditional mood stabilizer to control symptoms.Olanzapine can also be used alone for the treatment of bipolar disorder.Examples of antipsychotics used include: olanzapine (Zyprexa), ziprasidone (Geodon), quetiapine (Seroquel), aripiprazole (Abilify) and risperidone (Risperdal), all FDA-approved for the treatment of bipolar disorder.In addition, antianxiety medications such as benzodiazepines may be used in some people with bipolar disorder with acute mania to help with sleep. There is a potential for abuse of or physical dependence on benzodiazepines. Therefore, these medications are often prescribed only for a limited time, such as during an acute episode.