What to know about mood stabilizers
A person taking mood stabilizers may experience side effects, which can sometimes be serious.
Anyone with bipolar disorder may experience unusual changes in:
- activity levels
- the ability to do everyday activities
There are different types of bipolar disorder, but they usually involve significant changes in mood that can vary in intensity and duration.
These mood swings could involve manic episodes, in which a person typically feels very high-spirited and energized, and depressive episodes, in which a person usually feels very sad and lacking in energy.
What is a mood stabilizer?
A doctor may prescribe mood stabilizers to a person with bipolar disorder to help prevent mood swings.
According to an article in the journal CNS Drugs, mood stabilizers are generally drugs that:
- treat immediate symptoms of manic and depressive episodes
- help prevent people from experiencing these episodes in the future
Some mood stabilizers are more effective at targeting manic episodes, while others are better at treating depressive episodes. A person may take mood stabilizers on their own or in combination with other drugs.
Mood stabilizers and other drugs are usually only one part of the therapy plan for bipolar disorder. According to the National Institute of Mental Health (NIMH), effective treatment will include both medication and some form of talking therapy.
Types of mood stabilizers
As the article in CNS Drugs reports, researchers classify mood stabilizers as either first- or second-generation. Scientists in the 1960s developed first-generation mood stabilizers. These include:
Researchers in the 1990s developed second-generation mood stabilizers. These are atypical antipsychotic drugs that have mood-stabilizing properties. Second-generation mood stabilizers include:
In 1994, the Food and Drug Administration (FDA) gave approval for the use of the anticonvulsant drug lamotrigine as a mood stabilizer for people with bipolar disorder, as well as a treatment for epilepsy.
Like any medication, mood stabilizers are most likely to be effective if a person takes them as prescribed by their doctor.
According to NIMH, if a person wants to stop taking their mood stabilizers, they should speak to their doctor first to avoid any complications.
An article in the journal Molecular Psychiatry notes that lithium is the first-line treatment for manic and depressive episodes, although scientists are not yet sure precisely why it is effective.
The article reports that lithium is especially effective at reducing the risk of suicide among people with bipolar disorder who had not received treatment. It is one of the most effective treatments for bipolar disorder.
The author of the CNS Drugs article cited a study in which one-third of the 60 participants who took lithium to treat their bipolar symptoms had no manic or depressive episodes in the following 10 years.
The author points out that lithium primarily helps reduce mania, but it can also help improve depression.
According to study findings published in World Psychiatry, lithium was more effective than other mood stabilizers at treating symptoms of bipolar disorder.
The authors also found that lithium reduced the chances of a person with bipolar disorder needing supplementary medication, thus lowering the overall risk of unwanted side effects.
According to results of a study from 2012, published in the journal BMC Psychiatry, carbamazepine is also very effective at treating the symptoms of bipolar disorder.
A doctor might prescribe carbamazepine if a person has not responded well to lithium. Alternately, a person may take carbamazepine alongside lithium or other mood stabilizers.
According to the article in CNS Drugs, carbamazepine is primarily effective at treating a person's manic episodes.
According to a review in the Cochrane Database of Systematic Reviews, valproate may effectively treat the symptoms of bipolar disorder — especially over the longer term.
If a person experiences multiple side effects of lithium, or if lithium is not very effective, they may want to consider valproate, either instead of lithium or alongside it.
Atypical antipsychotic drugs
Research into the effectiveness of atypical antipsychotic drugs is still sporadic. Some new drugs show promise as treatments, but further research is necessary.
According to a review in the International Journal of Neuropsychopharmacology, atypical antipsychotic drugs could help treat manic episodes, and there is some evidence that they may treat depressive episodes as well.
Until scientists conduct more research, it is not clear whether:
- These antipsychotics work better than a placebo or lithium as a single therapy.
- People should use them alongside other treatments.
- A person should only try them if they have not responded well to other medications.
Lamotrigine is an anticonvulsant drug that doctors have — relatively recently — recommended as a key treatment for the symptoms of bipolar disorder.
A 2015 review in the journal Frontiers in Pharmacology concluded that lamotrigine was effective at treating these symptoms.
The authors highlighted evidence that lamotrigine could treat a person's depressive symptoms without destabilizing their overall mood, such as by increasing symptoms of mania.
However, because it is a relatively new drug for bipolar disorder, scientists need to do more research to find out how effective it can be. They also need to determine whether a person should take it as a monotherapy or in combination with other drugs.
Mood stabilizers may cause a person to feel very thirsty.
According to NIMH, mood stabilizers can cause significant, varied side effects. These can include:
- a rash, or general itching
- being very thirsty
- needing to frequently urinate
- shaking in the hands
- vomiting and nausea
- slurring of speech
- changes in heart rate
- changes in vision
- reduced coordination
- swelling in various body parts
Other, less common, side effects are also possible.
A review in the journal World Psychiatry noted that the side effects of mood stabilizers can vary significantly from one person to another.
This means that a doctor will closely monitor any side effects and that the person may need to try different drugs or combinations of drugs. The goal is to strike a balance between reducing the symptoms of bipolar disorder and minimizing any unwanted side effects.
According to NIMH, if a person is taking lithium to manage their bipolar disorder, they need to attend regular checkups to make sure that the lithium level in their blood is safe.
Mood stabilizers are a common treatment for bipolar disorder. Lithium can often reduce the symptoms, and some evidence suggests that other drugs, including more recently developed drugs, can have similar effects.
However, mood stabilizers can also cause significant side effects. When prescribing medication, the doctor's goal is to find a balance between reducing symptoms of bipolar disorder without causing significant unwanted side effects.