Mood Stabilizers

What are mood stabilizers?

Mood stabilizers are medications that help reduce extreme shifts in mood. They are primarily used to treat bipolar disorder.

What they’re used for

• Treating acute episodes of mania or hypomania
• Treating bipolar depression (some medications)
• Preventing future mood episodes (maintenance treatment)

Some are also used for other conditions, such as epilepsy or migraine prevention.

How they work

Exactly how mood stabilizers work is not fully understood. Lithium affects several signaling pathways in the brain. Anticonvulsant mood stabilizers affect nerve signaling in various ways.

How they’re taken

Usually taken by mouth daily. Doses are adjusted based on response, side effects and, for some medications, blood levels. This page does not provide dosing guidance.

Common side effects

• Lithium: thirst, frequent urination, hand tremor, nausea, weight gain.
• Valproate: nausea, drowsiness, weight gain, hair thinning, tremor.
• Lamotrigine: headache, dizziness, nausea; rash (see warnings).
• Carbamazepine: dizziness, drowsiness, nausea.

Serious side effects

Seek urgent medical advice for signs of lithium toxicity (such as severe vomiting or diarrhea, confusion, unsteadiness or coarse tremor), any new rash on lamotrigine or carbamazepine, yellowing skin, severe abdominal pain, or unusual bleeding or bruising.

Warnings

• Monitoring: lithium and some anticonvulsants require regular blood tests.
• Pregnancy: valproate in particular can cause serious birth defects; people who could become pregnant should discuss this carefully with their prescriber.
• Dehydration and illness: can raise lithium levels.

Interactions

Lithium levels can be affected by some pain relievers (NSAIDs), blood pressure medications and diuretics. Anticonvulsants can interact with many drugs, including hormonal contraception. Always check with a pharmacist.

Different medicines, different roles

“Mood stabilizer” describes medicines used mainly to prevent or treat the mood swings of bipolar disorder. They don’t all work the same way:

• Lithium has among the strongest evidence for preventing manic and depressive episodes and for lowering suicide risk in bipolar disorder. It requires blood tests and monitoring because the safe range is narrow.
• Valproate (divalproex) is effective for mania but carries serious risks in pregnancy and requires liver and blood monitoring.
• Lamotrigine is mainly used to help prevent depressive episodes, and is started gradually because of the risk of serious rash.
• Carbamazepine is used less often, and has many drug interactions and monitoring requirements.
• Antipsychotics are also commonly used as mood stabilizers; see antipsychotics.

Which one is chosen depends on your pattern of episodes, other health conditions, side effects, pregnancy plans and past response.

Why monitoring matters

Blood tests are central to safe use. For lithium, regular blood levels, kidney and thyroid checks help keep treatment in a safe and effective range. Dehydration, illness with vomiting or diarrhea, heavy sweating, some pain relievers (NSAIDs) and certain blood pressure medicines can raise lithium levels, so tell your prescriber about these. Signs of too much lithium, such as persistent nausea or diarrhea, coarse tremor, unsteadiness, confusion or slurred speech, need urgent medical attention. For valproate and carbamazepine, liver function and blood counts are monitored.

Rash with lamotrigine

Lamotrigine can cause a serious, sometimes life-threatening skin reaction. It is more likely if the starting schedule is not followed or if it is combined with some other medicines. Any new rash, especially with fever, sore throat, mouth sores or blistering, should be reported to a clinician immediately. Never restart lamotrigine after missing several days without checking with your prescriber, because the gradual start may need to be repeated.

Pregnancy and planning

Valproate can cause serious birth defects and developmental effects, and guidance advises that people who could become pregnant should only use it when other options are unsuitable and a pregnancy-prevention plan is in place. Other mood stabilizers carry different risks, and stopping medication abruptly also carries risks of relapse. Because many pregnancies are unplanned, discuss contraception and pregnancy plans with your prescriber early. Some medicines, such as carbamazepine, can reduce the effectiveness of hormonal contraception.

Taking mood stabilizers well

• Take them consistently, even when you feel well; stopping suddenly can lead to relapse, and with some medicines can cause withdrawal-type effects.
• Keep up with blood tests and appointments.
• Keep a regular routine, including sleep, which supports stability; see sleep and mental health.
• Limit alcohol and avoid recreational drugs, which can destabilize mood and interact with medicine.
• Carry a medication list and tell any new clinician what you take.

Therapy and support

Medication works best alongside education and therapy. Approaches such as psychoeducation, CBT, family-focused therapy and interpersonal and social rhythm therapy help people recognize early warning signs and keep routines steady. See psychotherapy. If you’re in crisis, or have thoughts of suicide, call your local emergency number or see Get Help Now.

Questions to ask your healthcare professional

• What monitoring will I need, and how often?
• Which side effects should prompt me to call you?
• How does this medication affect pregnancy or contraception?
• How long might I need to take it?

Mood stabilizers need regular follow-up and, for some, blood tests. Some online psychiatry services, such as Sesame, list lithium and lamotrigine among medications their psychiatric clinicians may prescribe or refill; arrange local lab testing if you use one.