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Mood Stabilizers

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Mood stabilizers are prescription drugs that even out bipolar mood swings. There are several medicines approved as mood stabilizers to treat bipolar disorder.1

The drug you take may change over time as your body changes. You also may need different drugs during a manic phase versus a depressed phase. Some mood stabilizers work best when used for what is called maintenance, or long-term stable moods. Others are better suited to mixed episodes or rapid cycling.1,2

Mood stabilizers may be used alone. Some also can be combined with antipsychotics and other medicines.2,3

How do mood stabilizers work?

Mood stabilizers work in a variety of ways to help balance moods. This is a big group of drugs, and each works in a different way. For example, lithium changes the way salt moves through nerves and muscles, but doctors do not understand why this helps stabilize moods.7

Some mood stabilizers are also antiseizure drugs. Experts do not fully understand why they work for bipolar symptoms. But they believe these drugs may calm brain activity.4-6

Examples of mood stabilizers

There are several brands and generic forms of mood stabilizers. The main prescription drugs used as mood stabilizers are:1-6

  • Lithium (Lithobid®, Eskalith®)
  • Valproate, valproic acid, or divalproex (Depakote®, Depacon®, Depakene®, Stavzor®)
  • Carbamazepine (Tegretol®, Carbatrol®, Equetro®, Epitol®)
  • Lamotrigine (Lamictal®, Subvenite®)

Lithium

Lithium is a standard for bipolar disorder because it stabilizes moods. This means it helps prevent extreme episodes of mania and depression. Lithium appears to work best in people with bipolar 1 disorder who do not have mixed features, rapid cycling, and other mental health conditions.1,2

Lithium is the only mood stabilizer that reduces the risk of:1,2

  • Suicide
  • Cancer
  • Heart disease
  • Stroke
  • Infections

People with bipolar disorder have all these conditions in higher numbers than the general population.1,2

Antiseizure medicines

Several of the medicines used to treat seizures also act as mood stabilizers. For example, valproate and carbamazepine are commonly used. They also seem to be more effective than lithium in treating rapid cycling and mixed episodes.2,5,6

Lamotrigine helps delay episodes in bipolar 1 and prevent depression in bipolar 2 disorder. It may be less effective at treating acute depression or mania. But it may help with the quick mood changes of cyclothymic disorder.1

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Some of the most common side effects of mood stabilizing drugs are:

  • Drowsiness
  • Dizziness
  • Stomach problems, including nausea, vomiting, stomach pain, or diarrhea
  • Headache
  • Dry mouth
  • Tremor or muscle weakness
  • Weight gain

Lithium has a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). It has this warning because it is possible to overdose on lithium. This is why regular blood tests are needed to monitor your dose, especially early in treatment.

Carbamazepine, valproic, and lithium all require regular testing until stable state is achieved. The frequency of testing will decrease once you and your doctor have found a dose that provides symptom relief without changing dose.4-7

Both carbamazepine and lamotrigine also have a boxed warning from the FDA. They have this warning because they may cause serious and life-threatening skin rashes.4,6

Valproate has a boxed warning from the FDA as well. This is because it may lead to:5

  • Liver damage
  • Harm to a fetus when taken by a pregnant person
  • Inflammation of the pancreas, this is called pancreatitis

These are not all the possible side effects of mood stabilizers. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking a mood stabilizer.

Other things to know

All medicines should be taken as prescribed. Skipping doses or stopping the medicine suddenly can trigger symptoms, such as mania or depression.6

Lithium can affect your liver and kidneys. If you take lithium, you will need regular blood tests to track your liver and kidney health.1,2

Some mood stabilizers are not safe to take while pregnant or breastfeeding. Talk with your doctor about how to manage pregnancy while staying as mentally healthy as possible. There is some evidence that being off all medicines while pregnant increases the risk of bipolar episodes, which is also a risk to the mother and baby.2

For children, therapy and lifestyle changes are usually recommended before mood stabilizers are considered.2

Before beginning treatment for bipolar disorder, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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