Home > Health Library > Mood Stabilizers for Child and Teen Bipolar Disorder
The above medicines are taken as tablets or capsules
These medicines are available in syrup, tablet, capsule,
and chewable tablet forms.
Mood stabilizers help even out the mood
swings linked with
bipolar disorder by balancing brain chemicals (neurotransmitters) that control emotions.
Carbamazepine, divalproex, 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.
Mood stabilizers may be used to treat
sudden manic episodes. Continued use of mood stabilizers can eliminate extreme
mood swings of
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.
Mood stabilizers have been well
studied in adults, but there are currently few studies in children.
Limited research shows that lithium is
safe and may be effective in reducing symptoms of bipolar disorder in children.1
Carbamazepine is an anticonvulsant
medicine which may be effective as a mood stabilizer in
children and teens who have bipolar disorder.2
Studies of divalproex show it to
be promising as a safe and effective treatment for children with mania due to
Research shows that lamotrigine
is effective in treating bipolar II in adults.3
Side effects of lithium may
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).
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 liver
inflammation and problems producing enough bone marrow. The most serious but rare side effect is
Stevens-Johnson syndrome. This causes sores on the
mucous membranes of the mouth, nose, genitals, and eyelids, and it can be
Divalproex can cause side effects such
as nausea, trouble sleeping, or dizziness. More serious but rare side effects include liver function problems,
pancreatitis, or a severe allergic reaction. Call your
doctor if your child is taking divalproex and complains of headache or experiences shaking, hair loss,
drowsiness or weakness, or a depressive episode or other psychiatric changes.
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.)
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 has intolerable side effects with 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
High blood levels of lithium carbonate can be
life-threatening. At first 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 (for example, Aleve), 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.
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)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Carlson GA, Meyer SE (2009). Early-onset bipolar disorder. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3663–3670. Philadelphia: Lippincott Williams and Wilkins.
American Academy of Child and Adolescent Psychiatry (2007). Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(1): 107–125. Available online:
National Institute for Health & Clinical Excellence (2006). Bipolar disorder: The management of bipolar disorder in adults, children, and adolescents, in primary and secondary care. London: National Institute for Health & Clinical Excellence (NICE). Available online: http://www.nice.org.uk/cg038
April 10, 2013
John Pope, MD - Pediatrics & David A. Axelson, MD - Child and Adolescent Psychiatry
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