Mood Stabiliser and Anticonvulsant Medications

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Category: Medical Options

What is it?

Mood stabilizers, sometimes called antikindling agents, are psycho-active medications usually prescribed to treat mood conditions such as bipolar disorder. Many mood stabilizers also act as anticonvulsants. Some experts suggest that these medications may also be useful for the treatment of certain PTSD symptoms.

There are several mood stabilizers and anticonvulsant medications available which each have a slightly different chemical makeup and effects. Those which have been documented for PTSD include:

  • Gabapentin (trade names include Neurontin)
  • Topiramate (trade names include Topamax)
  • Carbamazepine (trade names include Tegretol)
  • Valproate (trade names include Depacon)
  • Lamotrigine (trade names include Lamictal)
  • Lithium

How does it work?

The way that mood stabilizers work in the brain is better understood for some of these medications than others. Mood stabilizers and anticonvulsants appear to stabilize the membranes of nerve cells in the brain thereby making these cells less excitable and less likely to fire off inappropriate/unhelpful messages.

Is it effective?

A large body of evidence exists on the use of these medications to treat mood disorders and epilepsy or convulsions. There is however no high quality research evidence regarding the use of mood stabilizers/anticonvulsants for the treatment of PTSD symptoms. Some case studies and non-randomised trials have suggested benefits of these drugs for PTSD patients. Only one small randomized controlled trial has been published suggesting a positive effect of lamotrigine for certain PTSD symptoms. More research is required before the effectiveness of these drugs for PTSD can be established.

Are there any disadvantages?

Side effects from mood stabilizer/anticonvulsant medication usage are not uncommon and vary between the different medications. Reported side effects include dizziness, drowsiness, numbness or tingling, nausea and cognitive or memory problems. Other side effects are possible and health practitioners should be made aware of any changes. Some of these medications are known to interact with other drugs and caution should be used in combining with other medicines.

Where do you get it?

Mood stabilizers and anticonvulsant medications can only be prescribed by registered health practitioners.

What are the evidence limitations?

The evidence base for mood stabilizer/anticonvulsant medication use in PTSD is poor. Studies to date have been on small numbers of patients or of lower scientific quality. The methods of diagnosing PTSD were not reported in the review literature. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on current limited evidence, mood stabilizers and anticonvulsant medications cannot be recommended for the routine treatment of PTSD. Further research is required to establish the effectiveness and safety of mood stabilizers and anticonvulsant medications for PTSD patients. It is important that any drug treatment is provided by a registered health professional, with appropriate assessment carried out prior to treatment as well as ongoing monitoring during the course of treatment.

Key References

Berlant, J, Van Kammen, DP 2002, ‘Open-label topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: a preliminary report’, Journal of Clinical Psychiatry, vol. 63, pp. 15-20.

Cooper, J, Carty, J, Creamer, M 2005, ‘Pharmacotherapy for posttraumatic stress disorder: empirical review and clinical recommendations’, Australian and New Zealand Journal of Psychiatry, vol. 39, pp. 674–682.

Fesler, FA 1991, ‘Valproate in combat-related posttraumatic stress disorder’, Journal of Clinical Psychiatry, vol. 52, pp. 361-364.

Hamner, MB, Brodrick, PS & Labbate, LA 2001, ‘Gabapentin in PTSD: a retrospective, clinical series of adjunctive therapy’, Annals of Clinical Psychiatry, vol. 13, pp. 141-146.

Hertzberg, MA, Butterfield, MI, Feldman, ME, et al. 1999, ‘A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder’, Biological Psychiatry, vol. 45, pp. 1226-1229

Keck, PE Jr, McElroy, SL & Friedman, LM 1992, ‘Valproate and carbamazepine in the treatment of panic and posttraumatic stress disorders, withdrawal states, and behavioural dyscontrol syndromes’, Journal of Clinical Psychopharmacology, vol. 12, pp. 36S-41S.

Schoenfeld, F, Marmar, C & Neylan, T 2004, ‘Current concepts in pharmacotherapy for posttraumatic stress disorder’, Psychiatric Services, vol. 55, pp. 519-531.

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