Mood Stabilizers

What Are Mood Stabilizers?

Mood stabilizers are mental health medications used to treat mood disorders, particularly bipolar disorder, to help manage mood swings and prevent extreme highs (mania) and lows (depression). Mood stabilizers typically help control many symptoms of a manic episode that can affect daily life, such as difficulty sleeping, racing thoughts, and rapid changes in emotions.

Mood stabilizers are also used for other conditions, such as:

• Personality disorders, like schizoaffective disorder and borderline personality disorder
• Depression

They help regulate neurotransmitters (natural chemicals in the brain) involved in mood disorders, stabilizing overactive or overstimulated areas of the brain. Mood stabilizers aim to maintain a grounded emotional state.

Types of Mood-Stabilizing Drugs

Prescription mood stabilizer medications are generally categorized into three main types. Mood stabilizers affect the brain in different ways, but they all work by decreasing abnormal activity in the brain to help regulate mood. Lithium, anticonvulsants, and antipsychotics are all commonly used as mood stabilizers.

Lithium

Lithium is the oldest and most studied mood stabilizer available. It is a naturally occurring element found in some rocks and mineral springs. Lithium is primarily used with bipolar disorder to treat the symptoms of mania and prevent future manic and depressive episodes.

Researchers are still learning exactly how lithium works, but it is thought to regulate and strengthen connections in the brain and spinal cord involved in mood, thinking, and behavior, as well as affecting neurotransmitters. This helps control emotions, allowing people to cope better with mood swings.

Lithium tablets and capsules are available in immediate-release and extended-release forms. Brand names include Eskalith and Lithobid, which are both available in lower-cost generics.

Anticonvulsants

Anticonvulsants are medications originally developed to treat seizures but have since been shown to have mood-stabilizing properties. They are thought to reduce the excitability of nerve cells in the brain, reducing abnormal electrical brain impulses linked to seizures and brain chemical imbalances. This can make it less likely for mania or depression to occur.

Anticonvulsants also affect neurotransmitters in the brain, such as serotonin and dopamine, which help reduce the symptoms of mania and depression. Some anticonvulsants commonly used as mood stabilizers include:

• Lamotrigine (Lamictal): Lamotrigine works best at treating bipolar depression and preventing new episodes of depression. It doesn’t work as well for mania.
• Carbamazepine (Tegretol): Carbamazepine is used to treat manic episodes and prevent new episodes of mania.
• Valproate, Divalproex, valproic acid (Depakote, Depakene): Valproate (and its various forms) is often used to help treat episodes of mania and keep manic episodes from coming back.
• Oxcarbazepine (Trileptal): Like carbamazepine, oxcarbazepine is good at treating episodes of mania and stabilizing mood. Some people may have fewer side effects with oxcarbazepine compared to carbamazepine.

While these medications can be used as mood stabilizers, some may work better than others to treat certain symptoms.

Antipsychotics

Antipsychotics, which are often used in conditions such as schizophrenia, can also be used as mood stabilizers, particularly for bipolar disorder. They work by balancing dopamine and serotonin levels in the brain. Low serotonin levels are associated with depression. Too much or too little dopamine can cause psychotic symptoms in some people, but dopamine is also involved in mood regulation, making these medications useful as mood stabilizers as well. Common antipsychotics used as mood stabilizers include:

• Aripiprazole (Abilify) is mainly used to maintain a stable mood in people with bipolar disorder but is also used to treat manic or mixed episodes.
• Risperidone (Risperdal) is typically effective only for manic episodes and to maintain a stable mood.
• Olanzapine (Zyprexa) is effective for manic or mixed episodes (feeling both high and low at the same time) of bipolar.
• Quetiapine (Seroquel) is effective at treating manic, depressive, and mixed episodes of bipolar depression.

Healthcare providers may prescribe these medications to quickly treat mania or depression because they can provide relief within hours or days when other mood stabilizers are too slow-acting. Once symptoms are under control, some people can stop taking the antipsychotic. However, some people may need to continue taking both medications to stay healthy.

Natural Mood Stabilizers

Natural mood stabilizers are non-prescription supplements and vitamins that can help support mental wellness. They can also include coping methods and lifestyle changes that may help regulate mood. They may appeal to people who don’t want to take prescription medications because of concerns about side effects or costs.

Natural mood stabilizers can include adaptogens, omega-3 fatty acids, vitamin D, exercise, or meditation:

• Adaptogens are mushrooms or herbs believed to help the body regulate itself in many ways, including improving mood.
• Meditation can help calm the brain and aid in regulating emotions.
• Omega-3 supplements and vitamin D are needed to regulate serotonin, a chemical in the brain that helps regulate mood. Increasing omega-3 and vitamin D levels may contribute to improved mental health symptoms.
• Exercise has many benefits and has been shown to increase serotonin, norepinephrine, and endorphin levels in the brain. These natural neurotransmitters help you feel good and increasing them can lessen symptoms of depression.

Natural mood stabilizers are often not as effective as prescription medications. Although considered natural, they still come with risks, such as interactions with other medications or health conditions. Your healthcare provider can determine which form is best for you.

Side Effects of Mood Stabilizers

The side effects you might experience will vary depending on which kind of mood stabilizer you’re taking. Not everyone will have side effects, but many side effects tend to go away as your body gets used to the medication.

Talk with your pharmacist or healthcare provider about the side effects of the specific drug you are prescribed. Some common side effects may include:

• Upset stomach
• Rashes or itchy skin
• Drowsiness
• Weight gain
• Increased thirst
• Trouble sleeping
• Blurred vision
• Dry mouth
• Tremors

Some herbs and supplements may cause side effects, such as changes in blood pressure or hormone levels or an increased risk of bleeding. The FDA doesn’t strictly regulate herbs and supplements, so the purity, strength, and safety of products cannot be guaranteed.

Management of Side Effects

While taking some medications, such as lithium, valproate, or carbamazepine, your doctor will order regular blood tests to check the medication levels in your blood to ensure they aren’t too high or too low. Medication levels that are too high can cause side effects or make you sick. If they are too low, the medication may not work as well.

Talk with your healthcare provider if you have side effects that don’t go away or are bothersome. They can suggest ways to help manage them. Other things that may help reduce side effects include:

• You can take your medication dose with food or milk to reduce stomach upset.
• If your medication makes you feel too tired, your healthcare provider may recommend taking it at bedtime.
• Many mood stabilizers can cause weight gain. It’s important to exercise regularly and eat a healthy diet that includes fruits and vegetables to maintain a healthy weight.
• Some mood stabilizers can make your skin more sensitive to the sun. Wear sunscreen and protective clothing to help prevent sunburn.

Sometimes, your healthcare provider may adjust your dose or recommend a different medication if your side effects could be more manageable.

Complications of Mood Stabilizers

Mood stabilizers come with a range of potential complications that you should be aware of. These complications can vary significantly depending on the specific medication and an individual’s overall health.

Lithium Complications

Lithium use requires careful monitoring by a healthcare provider. One of the most serious risks is lithium toxicity, which can cause severe tremors, confusion, seizures, and even coma, making regular blood tests essential.

High lithium levels can occur if a person becomes severely dehydrated. Drinking plenty of fluids to stay hydrated is important, especially in hot weather or during vigorous exercise. Severe diarrhea, vomiting, or fever can also cause dehydration. If your lithium levels are too high, you may experience diarrhea, loss of balance, double vision, and weakness.

Long-term use may affect kidney function and thyroid health, leading to conditions like chronic kidney disease and hypothyroidism. Weight gain is a common side effect, which can lead to other health problems. Additionally, lithium can sometimes worsen skin conditions like acne and psoriasis.

Anticonvulsant Complications

Valproate use requires regular blood tests to check for liver damage or pancreatitis. It can also cause blood-related issues like low platelet counts, leading to increased bleeding. For women, valproate carries significant risks during pregnancy, which can lead to birth defects. Weight gain and metabolic issues can also be a concern.

Lamotrigine can cause serious skin reactions, such as Stevens-Johnson syndrome. While rare, these reactions require immediate medical attention. Aseptic meningitis, an inflammation of the brain and spinal cord membranes, is another serious but rare side effect of lamotrigine.

Carbamazepine can cause blood disorders and severe skin reactions. Your doctor will conduct regular blood tests to check liver health due to the risk of liver damage. Low sodium levels (hyponatremia) are also possible, leading to confusion or seizures.

Oxcarbazepine shares some risks with carbamazepine but tends to cause low sodium levels more frequently. It can also lead to dizziness and coordination issues, increasing the risk of falls.

Antipsychotic Complications

Antipsychotics, such as olanzapine, risperidone, and quetiapine, can lead to metabolic syndrome characterized by weight gain, diabetes, and high cholesterol, which may increase your risk of heart disease.

Drowsiness and problems with memory, thinking, or making decisions can affect daily life. Serious heart rhythm problems are possible, especially with ziprasidone. In women, menstrual issues and breast changes can occur.

A rare but serious condition called neuroleptic malignant syndrome is possible with all antipsychotics, with symptoms such as muscle stiffness and fever.

Who Can Prescribe Mood Stabilizers?

Only certain members of the healthcare community are legally able to write prescriptions for mood stabilizers. A doctor can write prescriptions for mood stabilizers, but they may also refer you to a psychiatrist if they feel you could use additional assistance treating your condition. Psychiatrists are medical doctors who are trained to treat mental health conditions and can write prescriptions.

In addition, physician assistants (PA) or nurse practitioners (NP) can also prescribe mood stabilizers.

You can buy natural treatments such as supplements and vitamins without a prescription at your local pharmacy.

What Conditions Do Mood Stabilizers Treat?

Mood stabilizers are used to treat various conditions, primarily those characterized by mood swings or instability. The most common condition mood stabilizers treat is bipolar disorder, where these medications help manage the extreme mood swings of manic and depressive episodes. Additionally, mood stabilizers can be used to treat schizoaffective disorder, which has features of both schizophrenia and mood disorders. Mood stabilizer medications are used to manage the mood-related aspects of the disorder.

For people with borderline personality disorder, mood stabilizers can help reduce mood swings and impulsive behaviors. However, they are not always the first choice for treatment. They also can be helpful for impulse control disorders, such as intermittent explosive disorder, by helping manage impulsive outbursts. In addition, they can be used to reduce aggression and irritability in various mental health and neurological conditions.

In some cases, mood stabilizers can be used in addition to antidepressants for depression when it doesn’t respond well to standard treatments. They can be added to antidepressants or other therapies to improve depression in people with bipolar disorder.

What if I Want to Stop Taking Mood Stabilizers?

People may decide they want to stop taking their medication for many reasons. If you feel you need to stop taking your mood stabilizer, talk to your healthcare provider first.

Suddenly stopping a mood stabilizer could have serious consequences. Mood stabilizers should be stopped slowly over 4 to 6 weeks. If you are taking Lithium, slowly decreasing the dose over 3 months is recommended. Your healthcare provider can give you recommendations to help you safely stop taking the medication.

After stopping a mood stabilizer, your healthcare provider will likely want you to have regular follow-up visits to ensure your symptoms aren’t returning.

Do Mood Stabilizers Affect Other Medications?

Mood stabilizers can affect and be affected by other medications you might be taking. They may affect how well your medications work or may increase your risk of side effects.

Anticonvulsants, such as carbamazepine, valproate, and lamotrigine in particular, can affect other medications. For example, carbamazepine can reduce the effectiveness of birth control pills in addition to other medications. Valproate can interact with antidepressants and blood thinners such as warfarin or aspirin, increasing the risk of side effects such as bleeding.

Antipsychotics, such as olanzapine and risperidone, can interact with a number of other drugs. These interactions can lead to increased drowsiness, changes in medication levels in your bloodstream, and other serious effects, especially when combined with sedatives or certain heart medications.

Always tell your healthcare provider about all the medications you are taking, including vitamins or supplements. Before using any over-the-counter medications, such as pain medications, cough syrups, or cold or allergy tablets, check with your pharmacist to make sure they can be used safely with your medications.

Does Alcohol Affect My Mood Stabilizer?

Mixing alcohol and a mood stabilizer could lead to serious side effects or worsening of your symptoms. If you look at your prescription bottles, you will see many of them say to avoid alcohol.

Alcohol can make some side effects of mood stabilizers worse, such as drowsiness, dizziness, and impaired coordination. This can increase your risk of accidents and injuries. Some mood stabilizers, particularly anticonvulsants like valproate and carbamazepine, are processed in the body by the liver or can cause liver damage. Drinking alcohol can increase the risk of liver problems.

In addition, alcohol is a depressant and can affect your mood. It can worsen symptoms of mood disorders, like bipolar disorder, and lead to mood swings or a relapse of symptoms. Research shows that individuals with bipolar disorder who drink alcohol are more likely to experience an increase in manic symptoms compared to those who do not drink.

While it may be possible to consume alcohol in moderation with certain mood stabilizers, it’s important to be aware of the potential risks and closely monitor for mood changes. Always consult your healthcare provider before drinking alcohol while taking mood stabilizers.

Can Mood Stabilizers Affect Driving or Operating Machinery?

Mood stabilizers may cause drowsiness or slow your reaction time, especially when you first start taking them. This could affect your ability to safely drive a car or operate other machinery. You shouldn’t participate in these or any other potentially dangerous activities until you know how the medication affects you.

What Else Should I Consider Before Taking Mood Stabilizers?

Mood stabilizers are the most commonly used treatment for bipolar and other mental health disorders. Maintaining a nutritious diet, exercising regularly, and ensuring sufficient sleep are vital. It’s also important to limit alcohol and caffeine intake.

Regular monitoring and follow-up are needed when taking mood stabilizers. This often involves regular blood tests to monitor drug levels and organ function, as well as close monitoring of mental health symptoms. This will help your doctor adjust your treatment plan if needed. Be sure you can commit to regular check-ups that are required for the safe and effective use of mood stabilizers.

Before starting treatment, tell your healthcare provider about your full medical history, including any other medical conditions you may have, such as thyroid problems, kidney issues, or cardiovascular diseases. Additionally, you should provide a complete list of all medications, supplements, and over-the-counter drugs you are taking because mood stabilizers can have significant interactions with other substances, which can decrease their effectiveness or increase the risk of side effects.

If you are pregnant or breastfeeding, it’s essential to discuss the risks with your healthcare provider. Some mood stabilizers can pose risks to a developing fetus or be transmitted through breast milk, so it might be necessary to adjust your medications or look at other treatment options.

It’s important to remember that the medications will take some time to work. While you may see some improvement early on in treatment, it can take up to several months for the medication to reach its full effect and to determine if it is working.

Everybody is different, and finding the right mood stabilizer might take some trial and error. Some people may have to try several medications before finding one that works.

Improving Overall Wellbeing with Mood Stabilizers

Mood stabilizers play an important role in stabilizing mood and improving mental well-being in people with various mental health conditions. These medications can help people perform daily activities, maintain relationships, and fulfill work or school responsibilities better, leading to an overall improved quality of life.

It’s important to work closely with your healthcare provider to help prevent side effects, manage complications, and find the best mental health treatment for you.