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Bipolar Disorder Treatment - Valproate and Carbamazepine

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Valproate (Depakote, Depakene)

Valproic Acid, also known as Sodium Valproate, Depakote, or Depakene, is often prescribed as a stabilizing medication for patients who do not tolerate lithium therapy well. There is good evidence from clinical trials that it is superior to a placebo (taking a pill that is basically sugar and other inactive ingredients). Research has shown that it is approximately equal to lithium in effectiveness, at least in the short-term. Since sodium valproate takes a shorter period of time to work than lithium, it may also be used as a short-term bipolar disorder treatment when rapid mood stabilization is required. It may be more effective than lithium for treating mania, bipolar disorder with rapid cycling, or mixed features. However, it does not seem to be as effective as lithium for the treatment of depressive states.

pile of yellow and blue pills The most worrisome side effects of sodium valproate bipolar medication treatment are liver damage and decreased platelets, both of which are important for maintaining normal blood functions. Among its many vital functions, the liver regulates blood clotting via platelets. At the onset of bipolar treatment, a liver enzyme function analysis and complete blood count should be evaluated for any given patient. These tests should be repeated regularly along with blood monitoring to measure circulating levels of sodium valproate so as to keep liver problems within an acceptable range.

Other side effects of sodium valproate bipolar treatment include:

  • nausea
  • sleepiness
  • increased appetite
  • weight gain
  • hair loss
  • decreased concentration
  • tremors
  • serious abdominal pain due to inflammation of the pancreas.

Long-term use in women has been associated with increased risk of ovarian cysts forming, which might possibly lead to infertility.

Because sodium valproate was initially discovered and used for the treatment of epilepsy, it is classified as an anticonvulsant rather than a mood stabilizer. Therefore, patients using other anticonvulsants should be aware that taking valproate can cause their monitoring results to be skewed. Also, aspirin may cause increased levels of blood valproate. Combining any of these medications should be done with extreme caution and only under the care of a doctor.

Carbamazepine (Tegretol)

Like sodium valproate, carbamazepine was developed as an epilepsy treatment. Because patients using this medication reported improvements in mood, it was used for some time as a bipolar disorder treatment. Because of its rather severe side effects and potential for interaction with other medications, it no longer plays a large role in bipolar treatment. However, there are some patients who respond better to it than to other options, so it remains on the list of drugs used as bipolar disorder treatments. Like lithium and valproate, carbamazepine exerts its most powerful punch on mania. Its effectiveness in treating depression symptoms and as a preventive agent is not clear.

Side effects of carbamazepine bipolar treatment include:

  • nausea
  • sleepiness or dizziness
  • increased confusion
  • decreased concentration
  • headache
  • abnormal heart rhythms
  • allergic reactions of the skin
  • increased liver enzyme activity.

Although a decrease in white blood cell or platelet count is rare with carbamazepine, it does occasionally occur, requiring regular blood monitoring while the drug is taken.

 

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