All About Mood Stabilizers for Bipolar Disorder

With bipolar disorder, your mood can go from a high feeling of euphoria, or manic episodes, to low feelings of depression, says Dr. Indra Cidambi, medical director at the Center for Network Therapy in New Jersey.

Also, people with bipolar disorder may experience changes in cognition.

“You may spend money irresponsibly during a manic episode, only to regret it later, or [experience thoughts of suicide] during a depressive episode,” says Cidambi. “Mood stabilizers work by eliminating the more extreme ends of these [rapid changes in mood], allowing you to function normally.”

Mood stabilizers will not cure bipolar disorder, but they can help balance your moods. This doesn’t mean you won’t experience different moods throughout the day, but you may have a lower chance of experiencing manic episodes or depression — the kind that can last for several days or weeks.

Lithium is the most popular and oldest of the mood stabilizer medications. It’s not clear how lithium works, but it “likely targets the activity of an enzyme or multiple enzymes inside cells,” Cidambi explains.

Some common types of mood stabilizers, with the common brand name, include:

• lithium (Eskalith)
• valproate (Depakote)
• carbamazepine (Tegretol)
• topiramate (Topamax)
• lamotrigine (Lamictal)
• gabapentin (Neurontin)

Doctors most often prescribe lithium for treating bipolar disorder symptoms.

The other medications above were initially developed to treat seizure disorders but can treat symptoms of bipolar disorder. They can also treat other conditions, such as borderline personality disorder and migraines.

You can get a mood stabilizer only by receiving a prescription from a licensed healthcare professional, not over the counter.

Three kinds of mood stabilizers vary in how they work to treat different mental health conditions:

• Lithium
• antipsychotics
• antiepileptic medication

These classes of mood stabilizers have been evaluated through clinical trials and research. This is why some — but not all — antipsychotic and antiepileptic medications are approved by the Food and Drug Administration (FDA) as mood stabilizers.

There are several types of bipolar disorder, including bipolar I disorder and bipolar II disorder.

Mood stabilizers are used to treat both.

• Bipolar I disorder consists of manic episodes and depression and is the condition many people think of as bipolar disorder. It’s more severe than bipolar II disorder, and most people who have this type have had major depression.
• In bipolar II disorder, you have cycles of major depression along with a milder form of manic episodes, known as hypomanic episodes.

“In bipolar II, it helps with moderating [manic episodes] and depression,” says Cidambi. “Although depression is less of an issue, mood stabilizers can still help with suicidal ideation or other negative thoughts.”

As with many medications, mood stabilizers can come with side effects.

Some common side effects you might experience include:

• nausea and vomiting
• weight gain
• hand tremors
• feeling tired
• dizziness

More severe side effects should be addressed right away. Different medications have their own severe side effects, including:

• Many mood stabilizers may cause suicidal thoughts or actions.
• In rare cases, lamotrigine (Lamictal) may cause Stevens-Johnson syndrome, which causes fever, body aches, and a peeling rash. According to experts, it may also cause aseptic meningitis, an inflammation of the brain and spinal cord membrane, along with blood or liver problems.
• Depakote may cause liver concerns, bruising, and pancreatitis, according to the National Alliance on Mental Illness (NAMI).
• Carbamazepine may cause low amounts of sodium in the body, according to NAMI.

Yes, you may experience withdrawal symptoms if you stop mood stabilizers because your body has gotten used to these medications. Though, in most cases, any withdrawal symptoms will be mild, according to Cidambi.

Stopping your medications, however, could cause your bipolar disorder symptoms to return.

In some cases, withdrawal symptoms might be more severe. Stopping Lamictal suddenly may lead to seizures or other concerns, such as nausea and vomiting, irritability, and relapse, according to the FDA.

Other withdrawal effects of mood stabilizers may include:

• trouble with balance
• difficulty sleeping
• difficulty concentrating
• changes in mood
• having thoughts of suicide or engaging in self-injurious behavior, or both
• anxiety
• muscle weakness

Mood stabilizer medications usually need to be tapered slowly. That means you stop using them by gradually decreasing the dosage over time. It’s a good idea to let a healthcare professional know if you’re experiencing withdrawal effects.

Mood stabilizers are different from antidepressants and can be used together with them to treat bipolar disorder.

According to a 2018 study, there is controversy surrounding whether antidepressants are effective in people living with bipolar disorder.

The study authors agreed that antidepressants work in many people with bipolar disorder but aren’t going to be effective for everyone.

Consider discussing with your doctor whether you would benefit from an antidepressant as part of your treatment plan.

Keep these safety considerations in mind when it comes to mood stabilizers.

Interactions with other medications

If you’re taking other medications while taking a mood stabilizer, it’s a good idea to make sure your care team is aware. Some medications may interact with mood stabilizers and can cause potentially harmful side effects.

Mood stabilizers in pregnancy

Being on a mood stabilizer during pregnancy might mean being monitored more closely or making adjustments to your treatment plan.

It doesn’t mean you can’t be on medications, and often it’s better to be on medications than not to be. Consider talking with your doctor if you’re pregnant or plan to become pregnant.

Alcohol use

Your provider may recommend not drinking alcohol or using substances while on mood stabilizers because it can increase sedative effects.

Black box warnings

Black box warnings are included on medication labels and provide information about severe or life-threatening side effects. Different medications will have black box warnings. For example:

• Lithium can be poisonous in high doses in your blood, a condition experts call lithium toxicity.
• Valproate has black box warnings for liver damage, inflammation in the pancreas, and birth defects, according to NAMI.
• Carbamazepine can cause rashes along with higher chances of infection because it can cause your white blood cell counts to decrease, NAMI says.

Overdose

It’s a good idea to notify your doctor or call 911 right away if you take too much of your medication. It may also be a good idea to call the poison control center, and they can help walk you through the next steps.

Currently, there are no over-the-counter (OTC) medications that have been approved by the FDA as mood stabilizers.

However, some OTC supplements are available that might help with the symptoms of bipolar disorder, though more research on this is needed. They include:

• St. John’s wort. The evidence is conflicting on whether this herb helps treat symptoms of depression. It also interacts with several medications.
• Valerian root. The research is mixed, but some research suggests valerian root may improve the anxiety and sleep issues many people with bipolar disorder can experience.
• Omega-3 fatty acids. According to a 2015 study, the omega-3 fatty acids found in fish, such as salmon, might help with mood-stabilizing for depression symptoms. This is thought to be due to the potential anti-inflammatory effects of omega-3s.

If you choose to use a supplement to treat your bipolar disorder, it’s a good idea to speak with a healthcare professional before doing so.

Mood stabilizers are a group of medications that can help you manage the symptoms of bipolar disorder. If you have received a diagnosis of bipolar disorder, consider asking your doctor to help you plan your medication.

Mood stabilizers may have side effects. If you experience them, don’t hesitate to tell your doctor. They will adjust your medication plan to find the right combination of medication types and doses that benefit you most. Living well with bipolar disorder means finding the treatment that works best for you.