Mood Stabilizers

This article provides an overview of mood stabilizer medications, including the benefits, specific types, side effects, and how they fit into a mental health treatment plan.

Key Takeaways:

• Mood stabilizers are mental health medications primarily used to control the severe mood swings that occur in bipolar disorder. They are often used long-term in these cases to reduce disease burden and avoid return of symptoms.

• Mood stabilizers work primarily by inhibiting excess activity in the brain and central nervous system. There are several different types, each with slightly different effects.

• There are several possible side effects and risks, some of which may be severe. Regular medical check-ups and thorough communication promote the most effective and safest treatment when using mood stabilizers.

Understanding Prescription Mood Stabilizers

Mood stabilizers are a class of prescription medications specifically designed to help control the manic and depressive episodes in bipolar disorder. This helps to manage the “highs” and “lows” that often cause significant distress and negatively impact overall well-being. ^{[1] [2]}

By promoting a more balanced mood, they can help with sleep, emotional regulation, cognitive function, and other important aspects. In addition, they’re designed to help symptoms from returning and from preventing severe symptoms that require hospitalization. ^{[1] [2] [3]}

How do Mood Stabilizers Work?

There are several effects of mood stabilizers, which all center around reducing excess mental activity. Specific effects vary between medications, but include inhibiting the inositol uptake process, increasing GABA production (which is an inhibitory neurotransmitter), and reducing the effects of glutamate (which is an excitatory neurotransmitter). Together, these effects reduce overactivity in the brain and nervous system. ^{[1] [2] [3]}

Conditions Traditionally Treated with Mood Stabilizers

The most common condition traditionally treated with mood stabilizers is bipolar disorder, which involves manic and/or depressive episodes. Manic episodes are periods of high energy, racing thoughts, inflated self-esteem, and euphoria, while depressive episodes are essentially the opposite, including very low mood, fatigue, and loss of interest or pleasure.

There are two types of bipolar disorder: ^[1]

• Bipolar I: which involves manic episodes

• Bipolar II: which involves hypomanic episodes with past or present depressive episodes

Mood stabilizers can be used to treat both types of bipolar disorder. ^[1]

Certain mood stabilizers are also approved for: ^[1]

• Prevention of migraines

• Seizures

• Trigeminal neuralgia

Off-Label Uses

Mood stabilizers are also used off-label for various conditions, such as: ^{[3] [4]}

• Borderline personality disorder (BPD)

• Schizoaffective disorder

• Depressive disorders

• Mood swings and aggression

• Post-traumatic stress disorder (PTSD)

Types of Mood Stabilizing Drugs

There are three main types of mood-stabilizing drugs:

• Lithium

• Anticonvulsants

• Antipsychotics

Lithium

Lithium is a naturally occurring element, and it is also present in small amounts in the body. It has been approved as a mood stabilizer by the U.S. Food and Drug Administration (FDA) since 1970. ^{[3] [5]}

Lithium is particularly used for controlling euphoric mania in bipolar disorder. It can help with elation, insomnia, irritability, anxiety, agitation, and suicidal ideation, among other things. While lithium is strongest therapeutically for the mania phase, it still shows some efficacy for the depressive phase of bipolar disorder. There is a relatively narrow therapeutic range for lithium, in which going too low or too high could lead to no effects or adverse effects, respectively. ^[6]

Brand names for lithium medications include:

• Eskalith® and Eskalith® Controlled Release

• Lithobid®

• Lithonate®

Anticonvulsants

Anticonvulsants were originally developed to treat seizures. Starting in the 1980s, researchers realized that they’re also helpful for mood stabilization and treating both manic and depressive episodes in bipolar disorder. ^{[3] [5]}

Additionally, anticonvulsants are often quicker-acting and have a wider therapeutic window compared to lithium, particularly valproic acid. ^[6]

The list of anticonvulsants includes:

• Valproic acid (Depakote®)

• Lamotrigine (Lamictal®)

• Carbamazepine (Tegretol®)

• Oxcarbazepine (Oxtellar®, Trileptal®)

Less common anticonvulsants that may occasionally be used for mood stabilization in certain circumstances include gabapentin (Neurontin®) and topiramate (Topamax®). ^[7]

Antipsychotics

Certain antipsychotics are also considered mood stabilizers. Examples include:

• Olanzapine (Zyprexa®)

• Clozapine (Clozaril®)

• Risperidone (Risperdal®)

Importantly, not all antipsychotics are mood stabilizers. Even the ones listed above typically aren’t the first drug of choice for mood stabilization.

How are Mood Stabilizers Prescribed?

Mood stabilizers can be prescribed by your primary care doctor or a mental health specialist, such as a psychiatrist. Several forms may be prescribed, such as capsules, tablets, solutions, oral dissolvents, and chewables. ^[1]

When to Seek a Prescription

The decision to seek a prescription for mood stabilizers should be based on the specificity, severity, and frequency of your symptoms.

Seeking a prescription is not limited to individuals who are already diagnosed with bipolar disorder. Any individual experiencing significant and severe mood swings that are greatly interfering with well-being and ability to function should likely discuss with their doctor about the possible utility of mood stabilizers.

Common Side Effects of Mood Stabilizers

Side effects of mood stabilizers differ depending on the type of medication prescribed. Listed below are common side effects by drug type: ^{[1] [3] [5] [7]}

• Lithium:

• Tremors

• Weight gain

• Hypothyroidism

• Nausea

• Fatigue

• Slowed thinking

• Excessive thirst

• Excessive urination

• Anticonvulsants:

• Weight gain

• Nausea

• Vomiting

• Tremor

• Easy bruising

• Diarrhea

• Mild hair loss

• Hyponatremia (low sodium level)

• Headache

• Drowsiness

• Vision changes

• Lethargy

• Itchiness or rash

• Antipsychotics:

• Extrapyramidal symptoms (related to movement), such as muscle spasms

• Restlessness

• Weight gain

• Metabolic disturbances (e.g., high blood sugar, high cholesterol)

• Sedation

• Dizziness

• Dry mouth

• Constipation

• Urinary retention

Rare Side Effects

In addition to the above, there are other rare side effects, some of which may be severe. These include: ^{[1] [5] [6] [7]}

• Nephritis (a type of kidney inflammation)

• Elevated liver enzymes

• Liver toxicity

• Pancreatitis

• Hyperammonemia (high ammonia in the blood)

• Brain damage (encephalopathy or toxicity)

• Stevens-Johnson syndrome

• Blood count abnormalities

• Lymph swelling

Common and rare side effects may reduce or go away completely as your body gets used to the medication. It’s important to monitor these side effects frequently and talk to your doctor if you have any concerns, especially if the side effects persist.

Are They Addictive?

Mood stabilizers are not addictive. Drugs that are addictive cause feelings of euphoria, involve a strong craving to continue using, and require continually higher amounts to achieve the same effect. None of these occur with mood stabilizers. ^[5]

While they are not addictive, your body does develop a tolerance to them over time. Thus, sudden stopping can result in withdrawal symptoms. Always talk with your doctor before deciding to stop mood stabilizers or reduce the dose.

Risks vs Benefits

Mood stabilizers can be highly beneficial in controlling symptoms, but they also come with risks. An overview of the main risks and benefits is presented in the table below:

Who Shouldn’t Take Them

Some individuals are at a greater risk of side effects and/or health consequences when taking mood stabilizers. This includes children, teens, pregnant and breastfeeding women. ^{[1] [5]}

In addition, there is an increased risk of side effects and interaction in individuals who regularly use alcohol, caffeine, “street drugs” (e.g., cocaine, marijuana), sedatives, diuretics, and anti-inflammatory drugs. ^{[1] [5]}

Some individuals may still be able to take mood stabilizers in these situations, while others will not. It’s essential to talk with your doctor to see what medication is safe and effective for you.

Long-Term Treatment Using Mood Stabilizers

Many individuals using mood stabilizers require long-term treatment, particularly since bipolar disorder has a high risk of relapse without treatment. Therefore, several steps are necessary to ensure safety and overall effectiveness when taking mood stabilizers long-term.

A vital part of long-term treatment is regular check-ins with your doctor and anyone else involved in your treatment plan, such as nurses, psychiatrists, and pharmacists. This is to make sure the medication is working effectively and that you’re not experiencing any significant side effects or health concerns. The doctor may also perform regular testing, such as for liver and kidney function, to ensure there is no damage. ^{[1] [5]}

Regular check-ups are also necessary to keep track of any new medications or supplements you’re taking to ensure there are no interactions. Always tell your doctor everything you take, whether it’s prescription or over-the-counter. ^[1]

Final Thoughts

Mood stabilizers are often a valuable part of bipolar depression treatment. They help reduce the severity and frequency of mood swings, which leads to better functioning and mental well-being. When taken long-term, they also reduce the risk of relapse. However, there are several possible side effects, interactions, and contraindications, some of which are severe. Always talk with your doctor to see what treatment plan is best for you.

Common Questions about Mood Stabilizers

How long can you take mood stabilizers for?

Many mood stabilizers can be taken indefinitely. This is often the case for individuals with bipolar disorder, since this situation requires long-term treatment to not only reduce symptoms, but also to prevent relapse. ^{[3] [5]}

Some individuals with depression or other conditions may only need to take mood stabilizers for a set period of time, such as several weeks or months.

Which mood stabilizers are most commonly prescribed?

The most commonly prescribed mood stabilizers are lithium, valproic acid, lamotrigine, and carbamazepine. ^[6]