My adult son has Bipolar I and has lacked the insight to take medication regularly for about ten years. Two years ago, he developed epilepsy and he refuses medication because the ones they have offered him are also used for bipolar disorder, and he thinks it’s a trick. Are there any seizure control medications that have no crossover for use in bipolar treatment?

Yes, only some seizure control or anticonvulsant medications have been shown to be helpful in reducing or preventing mood symptoms. There are three groups of anticonvulsant medication for treating of bipolar disorder:

Medications officially approved for treatment of bipolar disorder:

  • Valproate (brand name Depakote) is officially approved for acute or short-term treatment of manic and mixed episodes in bipolar disorder.  It is often used for maintenance or long-term treatment, but it is not officially approved for that purpose.  The evidence that valproate can prevent mood episodes over the long term is inconsistent.
  • Lamotrigine (brand name Lamictal) is officially approved for the prevention of depressive episodes, but has not been shown to be effective in the short-term treatment of mania, mixed states, or depression.  To diminish the risk of rare but serious skin rash, the dose must be increased slowly over several weeks so lamotrigine isn’t usually considered an acute treatment.
  • Carbamazepine (brand names Tegretol, Carbatrol, Equetro) has been used for acute treatment of manic or mixed episodes.  Only the Equetro sustained-release form of carbamazepine is officially approved for treatment of manic or mixed episodes, but reasonable evidence indicates that other forms are also effective. No form of carbamazepine is officially approved for long-term treatment, and there is no clear evidence that carbamazepine can prevent mood episodes over the long term.

Medications that are NOT officially approved, but have some evidence for effectiveness:

  • Oxcarbazepine (brand name Trileptal) is a close relative of carbamazepine.  It is not officially approved for treatment of bipolar disorder, but there is weak evidence that it may be effective for acute treatment of manic or mixed episodes.  There is no evidence that it prevents mood episodes in the long term.

Medications without evidence for effectiveness:

  • Gabapentin (brand name Neurontin) was used frequently for treatment of bipolar disorder, but controlled studies found it was no more effective than a placebo; however, it is sometimes helpful in the treatment of anxiety.
  • Topiramate (brand name Topamax) is often prescribed to help reduce appetite, but there is no evidence that it helps to control mood symptoms in the short or long term.
  • Zonisamide (brand name Zonegram) has been prescribed for both short- and long-term treatment, but the available studies do not show it to be better than a placebo.
  • Tiagabine (brand name Gabitril) has also been prescribed for short- and long-term treatment, but there are no controlled studies showing it to be effective.

There are reports of individual patients who have experienced improvement in mood symptoms after being treated with some of the other anticonvulsant medications.  However, mood symptoms can improve with or without medication.  That is good news, but it means we may give medication credit that it sometimes does not deserve.  Because every person can respond differently to medication, you’ll do best if you are well informed about your options and pay attention to your own individual response to different treatments.

DBSA does not endorse or recommend the use of any specific treatment or medication for mood disorders. Consult your doctor for more information about specific treatments or medications. Some of the uses under discussion above may not have been approved by the FDA.

About the Doc

About the Doc

Joseph Calabrese, MD, holds the Bipolar Disorders Research Chair and is Professor of Psychiatry at Case Western Reserve University. He is also the Director of the Mood Disorders Program within the Department of Psychiatry at the University Hospitals Case Medical Center. Dr. Calabrese co-directs an NIMH-funded ‘Bipolar Disorders Research Centre, whose projects include child and adolescent research conducted by Bob Findling, geriatric research conducted by Martha Sajatovic, dual diagnosis research conducted by Keming Gao, metabolic research conducted by Dave Kemp, and molecular genetics conducted by Jinbo Fan. Dr. Calabrese has received numerous research grants from the NIMH and other Federal agencies and has published over 300 peer-reviewed papers. Dr. Calabrese has received the NARSAD Lifetime Achievement Award in 2005 and the Gerald L. Klerman Lifetime Achievement Award in 2008.