Mood stabilizers for child and teen bipolar disorder

Examples

The above medicines are taken as tablets or capsules (orally).

These medicines are available in syrup, tablet, capsule, and chewable tablet forms.

How It Works

Mood stabilizers help even out the mood swings associated with bipolar disorder by balancing brain chemicals (neurotransmitters) that control emotions.

Divalproex, carbamazepine, and lamotrigine are anticonvulsants that doctors also use to treat seizures. It is not known exactly how these medicines affect mood, but experts think they may slow down certain electrical impulses in the brain that are linked to seizures and mood problems.

Why It Is Used

A mood stabilizer is usually the doctor's first drug of choice when treating sudden manic episodes. Continued use of mood stabilizers can eliminate extreme mood swings of depression and mania and improve your child's quality of life. Your doctor may prescribe mood stabilizers with other medicines (such as antipsychotics) for more effective reduction of mood swings.

How Well It Works

Mood stabilizers have been well studied in adults, but there are currently few studies in children.

Lithium

Limited research shows that lithium is safe and effective in reducing symptoms of bipolar disorder in children and may be particularly helpful for those who also have substance abuse problems.¹ Long-term use of lithium has also been shown to reduce the risk of suicide associated with bipolar disorder in adults.²

Divalproex

Recent studies of divalproex have shown it to be promising as a safe and effective treatment for children with mania due to bipolar disorder.¹ Divalproex has also been shown to help reduce rapid cycling between moods and is effective in adults with bipolar disorder who also have substance abuse or anxiety problems.³

Carbamazepine

Carbamazepine is an anticonvulsant medicine which has also been shown to be effective as a mood stabilizer in children and teens with bipolar disorder.¹

Lamotrigine

Initial research indicates that lamotrigine is effective in treating both depression and mania associated with bipolar disorder.³ Lamotrigine improves mood, alertness, and the way you relate to others. It has also been shown to be an effective treatment for rapid cycling.⁴ Lamotrigine is taken alone, without other medicines normally used to treat bipolar disorder.

Side Effects

Lithium

Side effects of lithium may include:

• Nausea, vomiting, and diarrhea.
• Trembling.
• Increased thirst and increased need to urinate.
• Weight gain in the first few months of use.
• Drowsiness.
• A metallic taste in the mouth.
• Bed-wetting (enuresis).
• Acne.
• Abnormal kidney function.
• Abnormal function of the thyroid or parathyroid gland.
• Increased number of white blood cells (not caused by an infection).

More serious side effects of lithium can include blacking out, slurred speech, and changes in heart rhythm or a heart block (problems with the heart's electrical signals that cause an abnormal heartbeat).

Divalproex

Divalproex can cause side effects such as nausea, trouble sleeping, or dizziness. Other, more serious side effects are rare but can occur and include liver function problems, pancreatitis, or a severe allergic reaction. Notify your doctor if your child is taking divalproex and experiences shaking, hair loss, drowsiness or weakness, a depressive episode or other psychiatric changes, or if your child complains of headache.

Carbamazepine

Side effects of carbamazepine can include dry mouth and throat, constipation, problems urinating, dizziness or drowsiness, nausea, vomiting, or loss of appetite. Rare but serious side effects include the risk of problems producing enough bone marrow, liver inflammation, and, most seriously, Stevens-Johnson syndrome, which causes sores on the mucous membranes of the mouth, nose, genitals, and eyelids and can be fatal.

People of Asian ancestry may be at a higher risk for skin problems, such as Stevens-Johnson syndrome, from taking carbamazepine. This and other skin problems, which include toxic epidermal necrolysis, can be dangerous. The FDA recommends that people of Asian background be tested before they take carbamazepine.

Lamotrigine

Lamotrigine was well-tolerated in initial studies. Some side effects occurred, including headaches, sleepiness, weight gain, and minor skin rashes that developed when people stopped taking the medicine. Serious negative side effects were uncommon. Rare side effects can include dizziness, blurred vision, nausea and vomiting, liver function problems and, most seriously, Stevens-Johnson syndrome.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

While these medicines have been well studied for use in adults, there are no long-term studies that confirm the effectiveness and safety of mood stabilizers in children and adolescents with bipolar disorder. Be sure to use these medicines exactly as your doctor prescribes them. If your child develops intolerable side effects to any of these medicines, call your doctor immediately.

Carbamazepine can interact with other medicines, and a doctor must carefully monitor your child's health when your child takes this medicine.³ Your child should not take carbamazepine along with monoamine oxidase inhibitors (MAOIs), because serious, sometimes fatal, reactions can occur.

Do not stop taking these medicines suddenly. Your child should taper off of these drugs slowly, with guidance from a doctor, to avoid negative and serious side effects.

High blood levels of lithium carbonate can be life-threatening. Initially your child will need to have his or her blood checked about every 2 weeks to measure the amount of lithium in the blood and to monitor kidney function. Make sure your child's doctor knows about all the medicines your child is taking; some medicines can raise or lower the effectiveness of lithium. Some nonprescription medicines, such as ibuprofen (for example, Motrin) or naproxen (Aleve, for example), can increase lithium levels in some people.

Regular blood tests are also needed to monitor the amount of carbamazepine and divalproex in the blood, and your doctor will need to test your child's liver periodically while he or she is taking these medicines.

Mood stabilizers may interact negatively with other medicines and should not be taken with some antibiotics or medicines that treat indigestion, seizures, or heart problems.

Mood stabilizers may increase the chance of birth defects. Be sure to tell the doctor if your child becomes pregnant.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

1. Kowatch RA, et al. (2000). Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39(6): 713-720.

2. Müller-Oerlinghausen B, et al. (2002). Bipolar disorder. Lancet, 359(9302): 241-247.

3. Sachs GS, et al. (2000). Expert Consensus Guidelines Series: Medication Treatment of Bipolar Disorder. Available online: http://www.psychguides.com/gl-treatment_of_bp2000.html.

4. Calabrese JR, et al. (2001). Bipolar rapid cycling: Focus on depression as its hallmark. Journal of Clinical Psychiatry, 62(Suppl 14): 34-55.

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