Mood Stabilizers

Mood stabilizers are a range of medications used to help manage extreme mood changes, often within the context of bipolar disorder. These medications can have various uses and may be used alongside other medications and treatments to help manage several different symptoms and conditions.

What are mood stabilizers?

Mood stabilizers are a collection of different medications that can be used to help stabilize extreme mood changes. Several different types of medications can be used as mood stabilizers, including antipsychotics and anticonvulsants, so this group of medications may have various uses and indications ^[1].

Types of mood stabilizers

Three types of medications are typically used as mood stabilizers: anticonvulsants (also known as anti-epileptic medications), antipsychotics, and lithium.

Anticonvulsants

Anticonvulsants that are commonly prescribed as mood stabilizers include ^[2][3]:

• Lamotrigine: Lamotrigine is often prescribed as a mood stabilizer and is available under the brand name Lamictal.
• Carbamazepine: Carbamazepine is a commonly prescribed mood stabilizer and is available in several forms, including a tablet, extended-release tablet, extended-release capsule, chewable tablet, and oral liquid. Brand names include Carbetrol, Epitol, Equetro, Tegretol, and Teril.
• Sodium valproate, valproic acid, and divalproex sodium: These medications are very similar and can all be prescribed as mood stabilizers. Divalproex sodium is a combination of sodium valproate and valproic acid. Brand names for these medications include Depakote, Depakene, and Epilim.

Antipsychotics

Antipsychotics that are commonly prescribed as mood stabilizers include ^[2][4]:

• Quetiapine: Quetiapine is an atypical antipsychotic medication often used as a mood stabilizer. Brand names include Seroquel.
• Aripiprazole: Aripiprazole is an atypical antipsychotic that can be an effective mood stabilizer. It is available under the brand name Abilify.
• Olanzapine: Olanzapine is an atypical antipsychotic that can be used as a mood stabilizer. It is available under the brand name Zyprexa and as a combination medication with fluoxetine under the brand name Symbyax.
• Risperidone: Risperidone is an atypical antipsychotic often used as a mood stabilizer. It is available under the brand name Geodon.

Lithium

Lithium is a unique medication not part of another class of medications. The medication is developed from a naturally occurring mineral and has been used for many decades as an effective treatment for bipolar disorder ^[1][5].

It is available as a tablet, capsule, extended-release tablet, and oral liquid. Brand names for this medication include Lithobid and Eskalith ^[6].

What are mood stabilizers used to treat?

Mood stabilizers are a group of several different types of medications that can treat many conditions. Typically, mood stabilizers are the collective name given to medications used to treat bipolar disorder, although each individual medication may have various uses ^[3].

Bipolar disorder often involves episodes of depression and episodes of mania or hypomania. Mood changes in bipolar disorder can be very extreme and thus require stabilizing with medication ^[4].

Different mood stabilizer medications have different purposes. They can be prescribed to individuals with bipolar disorder specifically to treat manic, mixed, or depressive episodes, or as a maintenance treatment. These medications can be prescribed alone or combined with another mood stabilizer or other type of medication ^[2][8].

• Lithium is often prescribed to treat acute mania or as maintenance treatment.
• The various anticonvulsant mood stabilizers can be prescribed to treat manic or mixed episodes or as a maintenance treatment.
• The uses of the different antipsychotic mood stabilizers include treating manic, mixed, and depressive episodes and as a maintenance treatment, depending on the specific medication.

Other uses

Mood stabilizers have various uses. However, they may not be referred to as mood stabilizers when used for other purposes.

Other uses of antipsychotic medications include ^[8]:

• Schizophrenia and other psychotic disorders
• Major depressive disorder with psychotic symptoms
• Personality disorders with psychotic symptoms
• Tourette’s disorder
• Managing aggression or agitation in the context of other conditions, such as autism, dementia, treatment-resistant depression, OCD, or anxiety.

Anticonvulsant medications are also used to treat several other conditions, both as FDA-approved uses and off-label, such as ^[9][10]:

• Epilepsy and other seizure disorders
• Anxiety disorders, such as social phobia, generalized anxiety disorder, and panic disorder
• Post-traumatic stress disorder (PTSD)
• Alcohol and benzodiazepine withdrawal
• Major depressive disorder (MDD)
• Schizophrenia and psychotic disorders
• Borderline personality disorder
• Specific symptoms of various conditions, such as aggression and cognitive impairment
• Migraines and other pain conditions

Lithium is typically only used in bipolar disorder as a maintenance treatment or in the management of acute mania ^[5]. However, it can also be prescribed off-label for ^[6][11]:

• Bipolar disorder with no history of mania
• Major depressive disorder, as an additional medication

Are antidepressants mood stabilizers?

Although antidepressants help to regulate and lift mood, they are not considered mood stabilizers. Antidepressants are sometimes used in the treatment of depressive episodes in bipolar. However, they are used with caution as they can cause the onset of a manic episode ^[1][12].

As such, antidepressants are not used to treat bipolar disorder alone but may sometimes be used alongside a mood stabilizer to help manage symptoms ^[7][12].

How do mood stabilizers work?

There are many different types of mood stabilizers, and they all work in slightly different ways. It is unclear precisely how mood stabilizers work, given that they can effectively treat several conditions.

Anticonvulsants

It is currently unclear exactly how anticonvulsants work in treating various conditions. It is thought that an excess of sodium and calcium in the body can contribute to several physiological and psychological symptoms, such as seizures, hyperactivity, mania, pain, and withdrawal effects. Anticonvulsants help regulate sodium and calcium levels, thereby reducing these effects ^[10].

Additionally, some anticonvulsants are seen to regulate levels of various neurotransmitters, including serotonin, depression, norepinephrine, and GABA. This may contribute to their antidepressant, antimanic, and anti-anxiety effects ^[3][10].

Typically, anticonvulsants have significant antimanic effects but minimal antidepressant effects. Lamotrigine is found to have a positive impact on bipolar depression and can prevent switching between episodes. As such, it may be an effective treatment for individuals with bipolar who experience severe depressive episodes ^[12].

Antipsychotics

Antipsychotics primarily work by impacting dopamine levels. Excessive dopamine activity is thought to be responsible for symptoms of psychosis and mania. Antipsychotics typically reduce dopamine levels, thus helping to reduce manic symptoms ^[8][13].

Atypical (second-generation) antipsychotics impact both dopamine and serotonin. As such, they can cause antimanic and antidepressant effects. They can also help to regulate mood long-term, as maintenance therapy, and reduce the impact of acute symptoms ^[4][14].

Generally, antipsychotics can be effectively used in lower doses to treat bipolar disorder than psychotic disorders. They might also be used alongside other mood stabilizer medications to augment their effects, such as anticonvulsant medications ^[14].

Lithium

The mechanism of action of lithium has yet to be fully understood. It is believed to have several actions that influence various functions, including ^[5][11]:

• Impacting sodium levels and transportation in nerve and muscle cells
• Increasing various proteins
• Impacting the metabolism of various neurotransmitters, particularly serotonin
• Impacting hormones, genes, and circadian functions

Research also indicates that lithium may even help to prevent the loss of brain volume that commonly occurs with long-term bipolar disorder by increasing grey matter volume. This neuroprotective effect may indicate potential benefits in neurodegenerative diseases such as Alzheimer’s and other dementias ^[5][11].

Its many effects are believed to contribute to its effectiveness in acute and long-term bipolar treatment. Lithium has been used for many decades and continues to be considered one of the best mood stabilizer treatments available. It is effective at managing episodes of mania and depression, suicidal ideation, and preventing recurring mood episodes ^[5].

However, it is not always the first choice of medication for this purpose due to its potential risks and health concerns related to long-term use.

Side effects of mood stabilizers

The potential side effects of the various mood stabilizers vary depending on the medication. When starting a new medication, it is common for side effects to occur, which will likely reduce within the first few weeks. However, if they become concerning or persistent, it is advised to consult your doctor, as you may need a reduced dose or medication change.

Anticonvulsants

Common side effects of anticonvulsant mood stabilizers include ^[3][15]:

• Nausea
• Vomiting
• Shaking
• Headaches
• Dizziness
• Blurred vision
• Drowsiness and fatigue
• Impaired memory or concentration
• Sexual dysfunction
• Fertility issues
• Irregular menstruation

Sometimes, serious side effects of anticonvulsant medications occur. If you experience any of the following, contact your doctor immediately ^[3][15]:

• Rashes or blisters
• Unexplained bleeding or bruising
• High temperature
• Yellowing of the skin or eyes
• Trouble breathing
• Severe joint or muscle pain

Antipsychotics

Common side effects of antipsychotic mood stabilizers include ^[8][16]:

• Increase in appetite and weight
• Nausea
• Vomiting
• Constipation
• Drowsiness and fatigue
• Dry mouth
• Sexual dysfunction
• Irregular or stopped menstruation
• Headaches
• Blurred vision
• Muscle stiffness

Sometimes, serious side effects of antipsychotic medications occur. If you experience any of the following, contact your doctor immediately ^[8][16]:

• Yellowing of the skin or eyes
• Increased blood sugar levels
• High blood pressure
• Sweating
• Fever
• Difficulty breathing
• Extreme stiffness or inability to move
• Seizures

Lithium

Common side effects of lithium include ^[6][11]:

• Nausea
• Vomiting
• Diarrhea
• Changes in appetite and weight
• Shaking or tremors
• Increased thirst
• Increased urination
• Dizziness
• Drowsiness
• Thinning or loss of hair

Sometimes, serious side effects of lithium occur, which might indicate toxic levels in your body, diabetes, or impaired thyroid or kidney functioning. If you experience any of the following, contact your doctor immediately ^[6][11]:

• Persistent or severe nausea or vomiting
• Confusion
• Delirium
• Feeling very unsteady
• Impaired vision
• Excessive thirst and urination

When using mood stabilizers, it is common for doctors to closely monitor your physical and mental health throughout treatment to assess for any changes or concerning effects of the medication. This may involve regular blood tests, particularly at the beginning of your treatment ^[7].