Mood Stabilizers

Mood stabilizers are the treatment of choice for bipolar disorder and adjunct treatments for other conditions.

Mood stabilizer medications are a versatile group of drugs that help treat several mental health conditions. Many of them are effective against physical disorders as well. Usage of mood stabilizer drugs requires detailed attention to the characteristics of these medications.

What are Mood Stabilizers?

Understanding what a mood stabilizer is and how a mood stabilizer works is essential to the proper treatment of disruptive mental health conditions. Mood stabilizers are mental health medications that help reduce the severity and frequency of mood swings.

Mood fluctuations are characteristic features of bipolar disorder, schizoaffective disorder and other disorders. But how do mood stabilizers work? Most of them act as brakes on the central nervous system, slowing down the flood of thoughts, images, preoccupations, ideas and words that people can experience during mania.

Background & History

The history of mood stabilizers begins with the history of lithium, which was used in the mid-1800s as a proposed treatment for gout. Lithium was able to break the urate crystals that cause joint pain in gout, so it promoted as a potential therapy. However, researchers soon noted its calming effect on people and animals who took it. After some time, lithium became a standard for the treatment of bipolar disorder.

Several other candidate drugs were developed and medications for other conditions were also “repurposed” to treat mood swings. However, when carbamazepine was used in the 1950s to treat “manic depression,” it marked the first time modern anticonvulsants (anti-seizure medications) were used to treat mental health conditions.

Use in Treating Mental Illness

Mood stabilizers are versatile drugs. Rather than use certain mood stabilizers for bipolar disorder, other mood stabilizers for depression and specific mood stabilizers for anxiety, providers use these medications to tailor treatment based on the patient’s needs.

The central features of bipolar disorder are sustained mood swings that can cycle between depression and either hypomania or mania. Mood stabilizers reduce the severity and frequency of these swings. Some mood stabilizers for bipolar disorder are prescribed when acute symptoms of mania have developed. Other mood stabilizers are prescribed as maintenance medications, meant to limit the level of mood symptoms as or before they develop.

Types of Mood Stabilizers

There are three types of mood stabilizers: lithium, anticonvulsants and antipsychotics.

1. Lithium

Lithium is an alkali metal, and the lithium drug that derives from it is a salt. It is considered the “classic” mood stabilizer, having been approved by the United States Food and Drug Administration (FDA) to treat manic symptoms for over 50 years. It is still considered the gold standard for the treatment and prevention of mania.

Lithium has what doctors and researchers call a “narrow therapeutic index,” meaning that small changes in dosage can have dramatic changes in the safety and effectiveness of the drug.

2. Anticonvulsants

These medications were originally developed to treat seizures but were found to be highly effective in treating symptoms of mania. Anticonvulsant drugs primarily work by increasing the availability of a messenger chemical between nerve cells, encouraging those cells to slow their communication.

• Valproic Acid (Depakote). Also known as sodium valproate and by similar names, valproic acid (along with lithium) is an FDA approved treatment for mania as well as the treatment of depression. It is also approved as a maintenance medication for bipolar disorder.
• Lamotrigine (Lamictal). Lamotrigine is not indicated for the treatment of acute manic symptoms, but it is FDA approved to treat acute depressive symptoms in bipolar disorder (along with atypical unipolar depression). It is also approved to be a maintenance medication for bipolar disorder.
• Carbamazepine (Tegretol). The oldest of this class of anticonvulsants, it is FDA approved to treat manic symptoms and can be used as a maintenance medication for bipolar disorder.

A mood stabilizers list often includes topiramate and gabapentin, but neither of these medications has shown enough data to be considered as a primary treatment for bipolar disorder.

3. Antipsychotics

In clinical practice, treating acute manic symptoms often requires the use of two or more medications. Though they are usually used to treat psychotic conditions like schizophrenia, antipsychotic drugs have sedating and mood-stabilizing properties. Such properties can help slow down the erratic and hyperactive nature of mania.

Because of this, antipsychotic medications are often used as a second or third medication alongside mood stabilizers, even when there are no symptoms of psychosis present.

• Aripiprazole: An atypical antipsychotic that has some activating properties.
• Ziprasidone: An antipsychotic medication that may also require electrocardiogram (ECG) monitoring.
• Risperidone: The first atypical antipsychotic. It can treat manic symptoms but can have some motor side effects.
• Olanzapine: The most commonly used antipsychotic to treat manic symptoms. When combined with fluoxetine, it is approved to treat bipolar depression.
• Quetiapine: Quetiapine can treat symptoms of mania, but it can also treat symptoms of depression. It is FDA approved for both purposes.

Mood Stabilizers Side Effects

Mood stabilizer side effects can range in severity from inconvenient to life-threatening.

Common lithium side effects include:

• Weight gain
• Nausea
• Fatigue

Symptoms of lithium toxicity include:

• Nausea
• Vomiting
• Trouble walking
• Confusion

Valproic acid is known for causing nausea and can be a cause of liver inflammation. Liver lab tests and a complete blood count should be checked when using this drug.

The most infamous side effect of lamotrigine is Stevens-Johnson syndrome. This condition begins with a fever, flu-like symptoms and a red, blistering rash that covers skin and mucous membranes and spreads towards the trunk of the body. This rash is rare, but it can be fatal if untreated.

Carbamazepine can decrease white blood cell counts, and its blood levels must be monitored.

Valproic acid, carbamazepine and lamotrigine should not be abruptly stopped due to the risk of seizure.

Possible Interactions

Mood stabilizers have some of the most significant drug interactions of any medication class. The interaction between valproic acid and lamotrigine is an example. Taking these medications together sharply increases the risk of Stevens-Johnson syndrome.

Carbamazepine is noted for increasing the breakdown of many active medications and deactivating them. Carbamazepine even deactivates itself, and if the drug is being regularly taken, its blood levels decrease unless the dosage is raised.

Taking Mood Stabilizers While Pregnant

Lithium, valproic acid and carbamazepine are all considered by the FDA as class D medications, meaning that human and animal studies have demonstrated clear risks to a fetus. Lamotrigine is considered a class C medication, meaning that animal studies have shown some evidence of minor risk to a fetus, but human studies are either inadequate or inconclusive.

In both cases, a woman considering taking mood stabilizers while pregnant should consult with her health care provider about the benefits and risks of taking them or not.

What to Do In Case of Overdose

A mood stabilizer overdose is a medical emergency. However, the chance that a mood stabilizer overdose will be fatal depends greatly on which mood stabilizer was taken, how much of it was ingested and which other medications or foods may have interacted with it. As with any overdose, emergency services like 911 should be activated immediately.

Get More Information on Mood Stabilizers

Additional information about mood stabilizers and the conditions they treat is available from the National Institute of Mental Health. You can also find medically accurate information about bipolar disorder, anxiety disorders, depression and many other mental health conditions from The Recovery Village.

If you or a loved one is considering treatment for a substance use disorder and are suffering from symptoms of a mental health condition like bipolar disorder, The Recovery Village can help. Give us a call and let us help you begin your road to recovery.  

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more