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• Bone marrow suppression
• Liver inflammation

Bone marrow suppression and liver inflammation are very rare side effects and can be minimized by monitoring blood levels and adjusting doses of medication accordingly.

Carbamazepine may interact with certain medications so it is important for the physician to know which drugs the patient is taking before prescribing carbamazepine. Oxcarbazepine is better-tolerated and easier to use.

Lamotrigine

This is a relatively new medication that is indicated for prevention of relapses of depression in bipolar disorder.

Side effects may include:

• Dizziness
• Headaches
• Vision difficulties
• Serious rash (rare) - increasing the dosage very slowly can minimize this side effect.

Lamotrigine is generally considered to have fewer side effects than most of the other mood stabilizers.

Gabapentin

Though this drug is used as a mood stabilizer, there is relatively little research regarding its efficacy when used for bipolar disorder. It appears to be helpful in reducing anxiety.

Gabapentin does not interact with most medications so it can be added to other mood stabilizers to enhance their effect.

Side effects include:

• Fatigue
• Sedation
• Dizziness

Topiramate

Preliminary research indicates that topiramate may be effective for mania in adolescents. It is different than the other drugs in that it does not cause weight gain and may even help in weight loss.

Side effects may include:

• Sedation
• Dizziness
• Cognitive disturbances
• Memory difficulties

Topiramate should not be taken by people with kidney stones.

Evidence suggests that abrupt discontinuation of mood stabilizers, especially lithium, is associated with very high relapse rates within several months, even after many years of mood stability. Recommendations are that, when necessary, discontinuation should occur slowly over time.

Antipsychotics

Antipsychotics are used to treat mania as well as control hallucinations or delusions that can occur with severe mania or depression. Antipsychotics are commonly combined with other drugs (e.g., mood stabilizers) but also can be used alone.

There are two kinds of antipsychotics:

• "Typical" or older antipsychotics
• "Atypical" or newer antipsychotics

"Typical" Antipsychotics

Drugs in this category include:

• Haloperidol (Haldol)
• Perphenazine (Trilafon)
• Chloropromazine (Thorazine)

Side effects may include:

• Tardive dyskinesia - repetitive, involuntary, purposeless movements of the tongue, lips, arms, and other parts of the body
• Muscle stiffness
• Restlessness
• Tremors

"Atypical" Antipsychotics

The atypical antipsychotics are a newer generation of drugs being used to treat bipolar disorder. Atypical antipsychotics include:

• Olanzapine (Zyprexa)
• Quetiapine (Seroquel) - This is the first antipsychotic medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of both the manic and depressive phases of bipolar disorder
• Risperidone (Risperdal)
• Clozapine (Clozaril)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)

In general, the newer atypical antipsychotics are less likely to cause certain distressing side effects associated with older antipsychotics, such as tardive dyskinesia (involuntary movement of muscles) and elevated levels of the hormone prolactin that can lead to menstrual problems, breast changes, and infertility.

Atypical antipsychotics are not, however, totally free of side-effects the most common of which include:

• Weight gain
• Drowsiness and somnolence
• Dizziness
• Nausea
• Hyperglycemia (high levels of glucose in the blood)
• Increased risk of diabetes
• Agranulocytosis - depression of white blood cells called granulocytes which leads to increased susceptibility to infections. This side-effect is of particularly associated with clozapine. Although other antipsychotics can cause agranulocytosis, the risk for developing this condition is about 10 times higher with clozapine.