Alternative Medications for Bipolar Disorder Treatment

Bipolar disorder is a mental health condition characterized by extreme shifts in mood, concentration, and energy levels. For treatment, healthcare professionals often prescribe a combination of medications, including mood stabilizers and antipsychotics. In recent years, alternative medications like anticonvulsants and calcium channel blockers for bipolar disorder have also been explored. Here’s what you need to know about these alternative treatment options.

Understanding Alternative Treatments for Bipolar Disorder

Bipolar disorder is a common mental health condition, and studies show that about 4.4% of U.S. adults experience it at some point. The aims of treatment are typically mood stabilization and preventive care.

Manic and depressive episodes are often treated with a combination of medications, including atypical antipsychotics, mood stabilizers like lithium, and anticonvulsants like sodium valproate. However, even with these medications, manic and depressive episodes still recur in many bipolar disorder patients^[1].

As a result, healthcare professionals have begun investigating alternative bipolar treatments. Some medications they’ve been studying as alternative treatments include lamotrigine, gabapentin, topiramate, and calcium channel blockers.

Lamotrigine in Bipolar Disorder Treatment

Lamotrigine is an anticonvulsant sometimes used to treat symptoms of bipolar disorder. Initially, lamotrigine was used as a maintenance treatment for those with bipolar I disorder to stabilize mood changes. However, further research has found that lamotrigine may be even more effective as a mood stabilizer in treating bipolar II disorder^[2].

Lamotrigine delays the time between mood changes by inhibiting sodium channels and decreasing the intensity of irregular electrical activity in the brain – helping even out moods. It can also be taken during episodes of bipolar depression.

Multiple studies support the use of lamotrigine for bipolar disorder. One study followed 124 patients in a depressive episode for 52 weeks. Sixty-nine of those bipolar patients ended up completing a year of treatment, and 81.4% achieved remission and reported fewer episodes of mania or hypomania than in the previous year^[3].

Overall, lamotrigine has proven to be an effective medicine for helping manage bipolar disorder episodes. It’s often taken in combination with lithium to stabilize moods.

Gabapentin as an Adjunctive Treatment

Gabapentin is an anticonvulsant most often used for controlling epileptic seizures, relieving nerve pain from shingles, and calming restless leg syndrome symptoms^[4]. Gabapentin is also sometimes used to treat the anxiety and agitation some individuals experience during a mixed or manic bipolar episode.

There have been mixed findings about gabapentin’s effectiveness in treating bipolar disorder. One study concluded that gabapentin had acute anti-manic and antidepressant properties for those with bipolar disorder^[5]. The study also mentioned that further double-blind studies were needed to determine the drug’s acute efficacy.

However, another study found that gabapentin wasn’t an effective treatment for bipolar disorder, and it didn’t do much more than a placebo. Overall, more research is needed to examine how gabapentin treats anxiety, mood disorders, and tardive dyskinesia^[6].

Topiramate: Emerging Evidence for Use in Treating Bipolar

Topiramate is an anticonvulsant healthcare professionals will sometimes prescribe when other mood-stabilizing drugs aren’t effective. This is because topiramate has a different chemical composition than other drugs used to treat convulsions or mood disorders. While topiramate isn’t currently FDA-approved for bipolar disorder, some physicians will prescribe it off-label.

Current research into this anticonvulsant for bipolar disorder has found some cases where topiramate is more effective for rapid cycling and mixed episodes than medications like carbamazepine and valproate. Topiramate also generally has a better side effect profile than many other mood stabilizers, which means it is often better tolerated by patients.

More research is needed into how topiramate treats bipolar disorder. While some small studies have been done regarding the use of topiramate, there haven’t been any large-scale studies yet to support its benefit^[7].

For example, one single-blind and randomized study found that patients in the depressive phase of bipolar disorder showed a 56% improvement in symptoms when treated with topiramate^[8]. Despite only including 36 patients, it and similar studies offer promise that topiramate can alleviate certain bipolar symptoms.

Calcium Channel Blockers for Bipolar Disorder

Calcium channel blockers are a class of drugs typically used to treat conditions affecting the heart and blood vessels, including high blood pressure and heart disease. These medications block the small pores in cells, known as L-type calcium channels, preventing calcium from entering the heart and blood vessels. This allows the blood vessels to relax and the heart to receive more oxygen^[9].

Research has shown calcium channel blockers can help alleviate symptoms of bipolar disorder. Research also suggests that in some people with bipolar disorder, the brain’s use of calcium to regulate specific nerve cells may not work correctly, potentially leading to manic episodes.

The calcium channel blockers that have been studied to treat bipolar disorder are Diltiazem, Isradipine, Nimodipine, and Verapamil^[1]. One study looked into Diltiazem and the drug’s effect on eight women with treatment-resistant bipolar disorder. The patients experienced a decrease in the severity of manic and depressive episodes, and the researchers concluded that calcium channel blockers may be an effective adjunctive treatment in the management of bipolar disorder^[10].

Another study looked into Isradipine’s effect on 10 patients with depressive episodes characteristic of either bipolar I or II. Of the four patients who completed the study, 10 experienced a 50% or greater symptomatic improvement with treatment ^[11].

While these studies have shown promising results, they have all been on a small scale. Further large-scale studies are needed to find out more about how calcium channel blockers can help those with bipolar disorder.

Side Effects of Alternative Bipolar Medication

All of these alternative bipolar medications have different side effect profiles. Often, these side effects are strongest when an individual begins taking the medication but lessen over time.

While taking any of these medications, seeing your healthcare provider regularly is crucial. Be sure to keep a list of your symptoms and report any changes to your doctor.

Lamotrigine Side Effects

Some of the side effects of lamotrigine for bipolar disorder include^[12]:

• Headache
• Diarrhea
• Nausea
• Insomnia
• Runny nose
• Non-serious rash
• Vivid dreams or nightmares
• Dizziness
• Drowsiness
• Fatigue

There is also a rare, serious side effect called Stevens-Johnson Syndrome. This typically begins with flu-like symptoms followed by a painful rash. Contact your healthcare provider immediately if you notice a skin rash, peeling or blistering of your skin, painful sores around the mouth or eyes, hives, or shortness of breath. Children ages 2 to 17 taking lamotrigine may be at increased risk of getting this syndrome^[12].

Gabapentin Side Effects

Some of the side effects of gabapentin include^[4]:

• Fever and sore throat
• Body aches
• Dizziness
• Swelling of legs and feet
• Difficulty speaking
• Nausea and vomiting
• Tremors and problems with balance and movement

The FDA also issued a warning about gabapentin in 2019. The medication may cause breathing difficulties for the elderly and individuals with underlying respiratory problems. If you notice your breathing slowing or changing, contact a doctor immediately.

Topiramate Side Effects

Topiramate’s side effect profile is different from other anticonvulsants. While many anticonvulsants can cause individuals to gain weight, topiramate causes weight loss.

Some of the other side effects you may experience while taking topiramate include^[13]:

• Blurred or double vision
• Back-and-forth or rolling eye movements
• Drowsiness and fatigue
• Confusion and forgetfulness
• Concentration problems
• Slowing of mental or physical activities
• Burning, prickling, or tingling sensations
• Clumsiness
• Nervousness
• Menstrual changes or increased menstrual pain
• Changes in the sense of taste
• Cold symptoms, including a stuffy nose, sneezing, or sore throat

Calcium Channel Blocker Side Effects

Calcium channel blockers generally have fewer side effects than other drugs used to treat bipolar disorder. Common side effects of calcium channel blockers include^[9]:

• Ankle swelling
• Flushing
• Heart palpitations
• Headaches
• Nausea and dizziness

Drinking grapefruit juice is not recommended while taking calcium channel blockers because it can increase the risk of side effects. The herbal extract St. John’s wort can also make calcium channel blockers less effective.

Integrating Alternative Bipolar Treatments

Overall, these alternative bipolar treatments have proven helpful in alleviating the depression and mania that come with bipolar disorder. They can work best in combination with a mood stabilizer. For example, lamotrigine is often taken in combination with lithium, divalproex, or quetiapine.

Finding the right treatment plan for you may also take a few tries. The right combination of medications will also depend on what other drugs you’re taking and how you’ve responded to different medications in the past. If you have any questions, contact your healthcare provider to discuss options.