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Mood Stabilizers

Mood Stabilizers are also categorized as anticonvulsants, but are defined by their effect rather than mechanism on the nervous system. Compared to antidepressants, controlled studies are limited for Mood Stabilizers, leaving information that is based only on studies that tend to contradict each other and reported side effects from patients.

Mood Stabilizer Medications:

  • Lithium
  • Valproic Acid (Depakote, Depakene, Depacon, Depacon, Depakine, Valparin, Stavzor)
  • Lamotrigine (Lamictal)
  • Carbamazepine (Tegretol)
  • Oxcarbazepine (Trileptal)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)

Lithium is the only mood stabilizer with published studies in the treatment of bipolar, but 55% of patients developed a resistance to lithium after 3 years and only an estimated 1/3 remained episode-free for two years. Because of lithium’s toxicity, regular blood levels are required to prevent risk to both kidneys and the thyroid. The therapeutic window for lithium is limited and dehydration may increase lithium levels as can antidepressants and neuroleptic agents, while both sodium and caffeine lower Lithium levels.

Because of Lithium’s limitations and shortcomings in treatment, other mood stabilizers are generally chosen, such as Valproic Acid or close derivatives.  However, due to toxicity, regular blood tests are required. Black box warnings exist in the packaging that warns of liver damage, neural tube defects to fetus’s and pancreatitis. Additionally, weight gain is a common side effect, yet mood stabilizers can have a terrible reaction when combined with artificial sweeteners, particularly aspartame.

Depakote and other antiepileptics are thought to act outside the brain cell on the GABA and Glutamate neurotransmitters, and in turn regulate the ion channels leading to the brain cell. These include sodium, calcium, chloride and potassium. Like Lithium, Depakote was found to grow new brain cells in rats.

Both aspirin and Depakote have blood-thinning effects, so combining with additional blood thinners is not recommended. Mood stabilizers are also known to cause tremors, and studies have shown that valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication prior to age 20.

One study in Israel found Carbamazepine (Tegretol) more than doubled the risk of major congenital anomalies during the first trimester of pregnancy. Birth rates were also lower and heart defects higher. The findings were corroborated by a 1999 Dutch study.

Gabapentin (Neurontin) is often prescribed for bipolar, but is frequently used for benzodiazepine withdrawals.  One double-blind study showed a placebo was more effective. Additionally, a scandal occurred over the drug when a whistle-blower notified authorities that Warner-Lambert, now part of Pfizer, aggressively marketed Neurontin for bipolar and other off label uses, even though no scientific evidence supported its efficacy.

Topiramate (Topamax) is a newer mood stabilizer that is receiving attention for it’s appetite-diminishing and weight-reducing properly. Unfortunately, it was not successful as a mania medication as its manufacturer had hoped, and after not having success in clinical trials, it was dropped from seeking FDA approval. Three depression studies had conflicting results. And although some people have reported benefit in the treatment, the drug noticeably dulls cognition and is unofficially known as “Dopamax”.

Side Effects May Include: Tremors, Gastrointestinal issues (including nausea and diarrhea, Headache, Vomiting, Dizziness, Upper respiratory infections, Aplastic anemia, Hepatic toxicity, Impaired learning and memory, Emotional affects such as irritability and agitation, Insomnia , Changes in vision, Fatigue, Cognitive, Impairment, Weight gain, Menstrual Abnormalities, Water retention, Pancreatitis, Dermatitis, Nervousness, Ataxia (incoordination and unsteadiness)

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