Anticonvulsants

What are anticonvulsants?

Anticonvulsants, also referred to as antiepileptic drugs (AEDs), and mood stabilizers, are a group of medications that were first designed to treat epileptic seizures but have since been found to also be useful in the treatment of mood disorders such as bipolar ^[1].

Epilepsy is a neurological condition that can cause several types of seizures that start in the brain and impact the central nervous system ^[2].

Bipolar disorder is a mental health condition that is characterized by episodes of mania and depression ^[3].

Symptoms of a manic episode can include ^[3][4]:

• Feeling euphoric, high, or elated
• Having a lot of energy
• A decreased need for sleep
• Talking and moving much more than usual
• Having an inflated sense of importance, intelligence, or power
• Engaging in impulsive or harmful behaviors

Symptoms of a depressive episode can include:

• Feeling very low in mood
• Having very little energy
• Sleeping more than usual or experiencing sleep disturbances
• Loss of interest in activities and hobbies
• Feeling worthless, guilty, or hopeless
• Changes in appetite, such as eating much more than usual or not feeling like eating at all
• Thoughts of self-harm or suicide

As there are many different types of anticonvulsants, there are various uses for this group of anti-seizure medications, as they work in different ways in the brain. As such, the type of anticonvulsant drug that is prescribed will vary depending on the condition it is being used to treat, as well as the individual’s response to the medication ^[5].

Types of anticonvulsants

There are many types of anticonvulsant medications used in the treatment of epilepsy, which are able to reduce the occurrence of seizures by acing on various channels in the brain, such as sodium and calcium channels, and reducing certain brain activity ^[6].

Some of these medications are also used to treat bipolar disorder, and are sometimes prescribed as an adjunctive medication alongside an antidepressant to treat other mental health conditions such as depression, anxiety, posttraumatic stress disorder (PTSD), and other mood disorders.

There have been several studies that show anticonvulsants are effective for use in treating bipolar disorder, although the results of this type of treatment may vary depending on the severity of the condition and whether mania or depression is the more prevalent symptom ^[3][7].

The actions of anticonvulsant medications on sodium and calcium channels have an impact on certain neurotransmitters, such as dopamine, serotonin, and GABA, which are then able to produce effects that reduce symptoms of mania and depression that occur in bipolar disorder ^[1].

Some of the anticonvulsant medications that are used in the treatment of bipolar disorder include carbamazepine, valproate, and lamotrigine ^[8].

Valproate

Valproate has been found to be effective in managing acute mania and mixed mania occurring in the context of bipolar disorder and may help to reduce rapid cycling. However, it has not been shown to have much effect on depressive episodes ^[3][7].

Valproate increases GABA, thereby impacting dopamine and glutamate in the brain, which is believed to be the mechanism by which it can reduce symptoms of mania ^[1].

Carbamazepine

Carbamazepine works in a similar way to valproate, also increasing GABAergic activity. It has been shown to be effective in reducing symptoms of acute mania and managing rapid cycling between episodes ^[9]. Carbamazepine is also somewhat effective in reducing the severity of depressive episodes ^[7].

Lamotrigine

Lamotrigine is considered a fairly unique anticonvulsant treatment for bipolar disorder, as it is much more effect than other medications of this class in treating depressive episodes. However, it has not shown much efficacy in managing manic symptoms ^[7][9].

Lamotrigine inhibits the reuptake of serotonin and norepinephrine, increasing levels of these neurotransmitters in the brain, thereby contributing to its antidepressant action and also making it a commonly prescribed medication for the treatment of depression ^[1][3].

Side effects of anticonvulsants

When taking a new medication, it is common to experience side effects. Usually, these will reduce as your body adjusts to the medication. However, if these adverse effects continue or become problematic, it is important to contact your doctor, as you may need a reduced dose or a change of medication.

Common side effects of anticonvulsant medications include ^[3][7]:

• Headache
• Sedation
• Nausea
• Dizziness and unsteadiness
• Blurred vision
• Weight gain

Sometimes, anticonvulsant medications can cause serious side effects. These may be signs of a severe condition, such as liver toxicity, kidney disease, allergic reaction, skin disorder, or pancreatitis. If you experience any of the following side effects, contact your doctor immediately ^[7][10][11]:

• Yellowing of the skin or eyes
• Severe abdominal pain
• Muscle weakness
• Vomiting
• Rash or hives
• Fever
• Swelling of the mouth or face
• Difficulty urinating
• Very dark urine
• Extreme fatigue
• Unexplained or unusual bleeding or bruising

Changes in mental state

Anticonvulsant medications can cause unexpected changes in mental state, such as new or worsening agitation, anxiety, mania, or depression, and may cause suicidal thoughts ^[10][11].

If you or your family members notice any concerning changes in your mental state, or you experience any thoughts of harming yourself, contact your doctor or mental health professional immediately.

What disorders do anticonvulsants treat?

Anticonvulsant medications are often prescribed for uses that are approved by the US Food and Drug Administration (FDA) and for others that are not approved but have been deemed necessary for treatment by a medical professional. The type of anticonvulsant prescribed will depend on the condition that is being treated.

Common uses of anticonvulsant medications include the treatment of ^[5][6]:

• Epilepsy
• Seizures
• Bipolar disorder
• Acute mania
• Migraines
• Chronic or neuropathic pain conditions
• Anxiety
• Restless leg syndrome

Alternative treatments for seizures

Anticonvulsant medication is the most effective treatment for epilepsy and seizures. As there are many different types of anticonvulsant medication, it may require the trial of several medications before finding the most effective treatment ^[5][12].

Aside from medication, treatment for epilepsy and seizures may involve ^[12]:

• Surgery: In some cases, surgery may be necessary to help control seizures, especially if medications have not helped. This involves removing or separating a part of the brain that is responsible for causing seizures. A doctor or specialist will decide if it is an appropriate treatment and will discuss the potential risks and complications of this option.
• Vagus nerve stimulation: VNS involves connecting a small device inside the body that sends electrical pulses to the vagus nerve, in order to reduce the activity that causes seizures. Again, a doctor or specialist will decide if this is an appropriate treatment and will provide information about the potential benefits and risks of this treatment.
• Diet: Some types of epilepsy and seizures can be potentially controlled by the use of a ketogenic diet. A dietician and epilepsy specialist will be involved in the decision to implement this treatment and will provide the necessary information on how to utilize this diet.

Alternative treatments for bipolar disorder

Bipolar disorder is often effectively managed with the use of medication and therapeutic treatment ^[13].

Medication

While anticonvulsant medications can be effective treatment as a mood stabilizer for bipolar disorder, some people require the use of other medications, or a combination of medications to effectively manage their symptoms. This might include ^{[3][8][13][14]}:

• Lithium: Lithium is considered a very effective treatment in the long-term management of bipolar disorder, but also has the potential to cause severe side effects. As such, lithium treatment involves regular physical health monitoring to prevent or manage serious effects.
• Antidepressants: An antidepressant medication may be prescribed alongside another medication to treat depressive episodes that occur in bipolar disorder. However, for some people, antidepressants can cause the occurrence of a manic episode and so should be used with caution in bipolar treatment.
• Antipsychotics: Antipsychotic medications can be effective in treating episodes of acute mania, bipolar with psychotic symptoms, or as a long-term treatment of bipolar disorder, either as the only medicinal treatment or as an adjunctive treatment with an antidepressant.

It is crucial to always take your medication exactly as prescribed by your doctor to prevent serious adverse events or a worsening of symptoms. Also, ensure that you inform your doctor of any concerning side effects that you experience, as you may need a change in dosage or medication.

Therapy

Utilizing therapy alongside medication is often the most effective way to manage symptoms of bipolar disorder. This may include ^[13][14]:

• Talk therapy: Interpersonal therapy and cognitive behavioral therapy (CBT) can help to manage episodes of depression in bipolar disorder, by providing skills to tolerate distress, understand triggers, and alter negative thoughts and behaviors.
• Family therapy: It can be useful for family members to attend therapy together, to provide education and understanding of bipolar disorder, learn how best to support the management of symptoms, and develop ways to overcome any challenges that may arise at home.
• Group therapy: Some people find it useful to attend group therapy with others who have a similar diagnosis, as it can provide emotional support, the opportunity to share experiences, and teach new skills in managing symptoms.

Inpatient treatment

If there is a risk of serious harm to the individual or others, inpatient treatment in a mental health hospital may be required, in order to stabilize symptoms. Typically, this is only required short-term, with the individual being discharged from hospital as soon as their condition is stable, and they are deemed to be safe from harm ^[14].