Medications Part 2 – Anticonvulsants

Some anticonvulsants are found to have a mood stabilizing effect. These medications are a first or second line treatment in bipolar disorder, with lithium being one of the first. More modern anticonvulsants often have less side effects. For example, Epival (Depakote in the USA) is great for rapid cycling, when lithium is only partially effective.

The three most commonly used are Depakote, Lamictal and Tegretol, or Trileptal (a newer version of Tegretol). If those fail, other meds like Topamax or Gabapentin can help. Gabapentin also works great for anxiety. Dilantin, one of the oldest seizure medications, is used, but not very often anymore. These are the main medications I’m going to cover in this article, and I’ll add some personal experience to them as well.

Why anticonvulsants?
There is a link between bipolar disorder and seizure disorders, but these medications are made to control seizures. Why do they also control mood?

They calm nerves in the brain, making them less excitable1. This evens out the chemical imbalance. They do take a bit to work and have unpleasant side effects at times. Most antivonculsants need to be “titrated up”(2) With medications like Lamictal, this can be very frustrating. Lamictal is approved to treat bipolar depression, as well, but it comes with the potential, 1/3000 odds of getting Steven-Johnson’s Syndrome3, which, for a quick explanation, is a flesh eating rash that is potentially fatal.

I titrated up slowly on Lamictal in the hospital and one day I broke out in a rash. They confirmed it was Steven-Johnson’s Syndrome and took me off the Lamictal immediately and gave me another mood stabilizer, because even if you’ve never had a seizure before, rapid discontinuation of an anticonvulsant can cause seizures, in very rare cases.

Some anticonvulsants need blood work done, but not necessarily to establish a therapeutic level, like with lithium. Depakote needs blood levels done to check on the liver, as it can be hard on the liver.

Depakote is usually the first tried, at least with me, anticonvulsant. It is approved for bipolar disorder and helps with rapid cycling more than lithium, or other anticonvulsants. It is also a first-line treatment with seizure disorders. It has some unpleasant side effects4, it should not be taken while pregnant or breastfeeding, it can cause birth defects. Hair loss, liver toxicity, pancreatitis are other side effects, while rare, they do happen, so this medication must be monitored by a doctor. It can also, ironically, make you suicidal.

My experience with Depakote, the first time, well, it made me suicidal, and I attempted suicide. This landed me in the ER chugging charcoal and my psychiatrist refused to see me after that. They just sent me home and told my parents to hide the pills. I was 17. It knocked me out for the first couple of weeks, but I’m on it now, and I don’t have nearly as many problems. Minor side effects are stomach upset, hair loss, both of which I’ve never had problems with. I currently take 1000mg of Depakote a day in my “cocktail” (Depakote, Luvox, Xanax, Abilify and Benadryl). I’d recommend this drug, it is quite helpful.

Tegretol is similar to Depakote. It used to be an off-label prescription, but has been approved for bipolar disorder under a new name. It is good for mixed states and manic states, and is often used if lithium and Depakote fail6. Unfortunately, it can cause other medications (like antipsychotics, antidepressants, birth control, and more) to become less effective. It can also affect white blood cell count. Trileptal is similar, but newer, and has less side effects. It doesn’t require regular blood levels but it can lower sodium levels in the bloodstream. I haven’t taken Trileptal, but Tegretol made me halucinate. It did come in tasty chew tablets, though.

Lamictal is approved to treat bipolar depression and also works as a mood stabilizer. It isn’t an antidepressant, but it has antidepressant effects. It is considered one of the most long term treatments for bipolar disorder7. There aren’t a lot of side effects, but the ones you get can be bad. There is a potential to develop Steven-Johnson’s Syndrome (I did, because I’m damned like that)3. You need to very slowly titrate2 up or you can end up with SJS or another type of rash that isn’t as dangerous. It works best for Bipolar II.

It starts working when you’re in the 200mg-400mg dosage range8. It can begin working very quickly at low doses for depression. It is often considered the best medication for people with bipolar disorder, but does have it’s side effects. There is a risk of mania, because of the antidepressant qualities. There is the risk of “the rash3”, and a lot of anxiety while titrating up. It can impair cognitive functioning a bit and cause drowsiness. If the benefits outweigh the side effects, this is a good drug.

Topamax is an anticonvulsant used for seizures and migraine prevention. It is also used for bipolar disorder off-label. It just went generic, so my insurance covers it, and I tried it for about two months, but the nickname “dope-a-max” comes to mind. Titrating up sucked, I was tired all the time. It has one good side effect: weight loss, but it can cause foods to taste differently. Like pop, Coca-cola just tasted off. It comes in pill or sprinkle form.

It has major side effects at times and can effect congitive functioning, kidney stones/damage, glaucoma, extreme sensitivity to heat and making the blood to acidic9. It is a last-line treatment for bipolar disorder.

Gabapentin (Neurontin)
This is another anticonvulsant drug and also helps with neuropathic pain. It is not effective on it’s own for bipolar disorder, but it pretty handy with anxiety. It can cause suicidal thoughts or actions and has a hellish discontinuation syndrome.

“Neurontin has not been shown to be effective in treating acute mania or depression. In other words, if you’re currently experiencing mania or depression, Neurontin will not be effective in stopping the acute mood episode.10”

There are minor side effects, and it can be added on as a treatment for bipolar disorder, but lithium, depakote and lamictal are better first-line treatments.



  2. Titration is starting at a low dose and adding to it until the therapuetic level is reached.