Controlling Mania with Anticonvulsants

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Not all patients with symptoms of mania benefit from lithium. Some have been found to respond to another type of medication, the anticonvulsant medications that are usually used to treat epilepsy. Carbamazepine (Tegretol) is the anticonvulsant that has been most widely used. Individuals with bipolar disorder who cycle rapidly, (changing from mania to depression and back again over the course of hours or days, rather than months) seem to respond particularly well to carbamazepine.

Early side effects of carbamazepine, although generally mild, include drowsiness, dizziness, confusion, disturbed vision, perceptual distortions, memory impairment, and nausea. They are usually transient and often respond to temporary dosage reduction. Another common but generally mild adverse effect is the lowering of the white blood cell count which requires periodic blood tests to monitor against the rare possibility of more serious, even life-threatening, bone marrow depression. Also serious are the skin rashes that can occur in 15 to 20 percent of patients. These rashes are sometimes severe enough to require discontinuation of the medication.

In 1995, the anticonvulsant divalproex sodium (Depakote) was approved by the Food and Drug Administration for manic-depressive illness. Clinical trials have shown it to have an effectiveness in controlling manic symptoms equivalent to that of lithium; it is effective in both rapid-cycling and non-rapid-cycling bipolar.

Though divalproex can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases divalproex has caused liver dysfunction, liver function tests should be performed prior to therapy and at frequent intervals thereafter, particularly during the first six months of therapy.

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Reviewed: 03/2006