What mental illness needs mood stabilizers?

Complete List of Mood Stabilizers: Types, Uses, Side-Effects

There is a whole list of mood stabilizers, and they are all slightly different. Medical professionals group these drugs together because they help to stabilize mood and prevent, manage or reduce depressive and manic episodes in people with bipolar disorder. The effectiveness, side-effects and recommended doses of these drugs vary, and many people want to explore their options before committing to a course of treatment. Here is a mood stabilizers medication list, as well as some important facts about each medication.

The Complete Mood Stabilizers List

There is a long list of mood stabilizers, and what is right for one person may not be right for another. Three types of medications fall into the category of mood stabilizers: minerals, anticonvulsants and antipsychotics.

Mineral Mood Stabilizers

Lithium is commonly used to treat depression and mania in bipolar disorder. It was approved by the FDA in 1970 and is still used in a number of cases today. It can be prescribed alone or along with other medications that treat bipolar disorder. Commercial brand names for lithium medicines include Eskalith, Lithobid and Lithonate.

Lithium is highly effective when used to stabilize mood, but it can cause side-effects. These include:

Nausea
Fatigue
Tremor
Weight gain
Confusion
Diarrhea

High levels of lithium in the blood can be dangerous, so doctors will routinely monitor your health via blood tests if you take lithium medications.

Anticonvulsant Mood Stabilizers

Anticonvulsants are commonly prescribed to patients with epilepsy, but they are also highly effective at reducing the severity and frequency of bipolar episodes. There is a long list of mood stabilizers in this category, but commonly prescribed medicines include:

Valproate/valproic acid (Depakote, Depakene)
Lamotrigine (Lamictal)
Carbamazepine (Carbatrol, Tegretol, Epitol, Equetro)

The following anticonvulsants are sometimes used “off-label,” meaning they are not officially approved for the treatment of bipolar disorder, but the FDA approves them for other purposes. Doctors can prescribe off-label medications for the benefit of a patient’s care.

Oxcarbazepine (Oxtellar, Trileptal)
Gabapentin (Horizant, Neurontin)
Topiramate (Qudexy, Topamax, Trokendi)

Common side-effects of anticonvulsants are similar to those of lithium, but they may also include headaches, sexual problems, abdominal pain, fever, confusion, blurred vision and abnormal bruising and bleeding.

Antipsychotic Mood Stabilizers

Antipsychotics are another medication type on the mood stabilizers list. In some cases, they are prescribed alone, but they may also be taken with other mood stabilizing drugs. Medications in this category that are approved for the treatment of bipolar disorder include

Aripiprazole (Abilify)
Asenapine (Saphris)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Lurasidone (Latuda)

Antipsychotic medications can cause side-effects. These may include:

Tremors
Blurred vision
Weight gain
Dizziness
Rapid heartbeat
Sensitivity to sunlight

All side-effects should be reported to your doctor. If you experience swelling of the hands or face, difficulty breathing, body rash or irregular heart rhythms, you should seek medical assistance immediately. Some drugs on the mood stabilizers medication list can also cause adverse mood symptoms, such as suicidal thoughts and behavior, hallucinations and problems with memory. If any of these occur, it’s important to seek immediate medical advice.

Which Drug on the Mood Stabilizers Medication List Should I Choose?

If you are diagnosed with bipolar disorder, your doctor will examine your symptoms, medical history, allergies, intolerances and other general health factors to determine which course of treatment is right for you. You may need to try different medications from the mood stabilizers list to determine which works best.

During this time, it’s important to meet with your doctor regularly to report any side-effects and see how well your treatment is working. Your doctor can then make periodic adjustments to your medication to keep your side-effects and symptoms under careful management.

See Also:

Side-Effects of Mood Stabilizers and How to Manage Them
Mood Stabilizers for Kids: Are They Safe and Effective?
Mood Stabilizers in Pregnancy: Are They Safe?
Do Mood Stabilizers Help Manage Bipolar Anger?
Are There Natural Mood Stabilizers for Bipolar? (And Do They Really Work?)

APA Reference
Smith, E. (2021, December 28). Complete List of Mood Stabilizers: Types, Uses, Side-Effects, HealthyPlace. Retrieved on 2023, May 7 from https://www.healthyplace.com/bipolar-disorder/bipolar-medications/complete-list-of-mood-stabilizers-types-uses-side-effects

Last Updated: January 7, 2022

Medically reviewed by Harry Croft, MD

Mood stabilizer

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, such as bipolar disorder and the bipolar type of schizoaffective disorder.

Uses [ edit ]

Mood stabilizers are best known for the treatment of bipolar disorder, [1] preventing mood shifts to mania (or hypomania) and depression. Mood stabilizers are also used in schizoaffective disorder when it is the bipolar type. [2]

Examples [ edit ]

The term «mood stabilizer» does not describe a mechanism, but rather an effect. More precise terminology based on pharmacology is used to further classify these agents. Drugs commonly classed as mood stabilizers include:

Mineral [ edit ]

Lithium – Lithium is the «classic» mood stabilizer, the first to be approved by the US FDA, and still popular in treatment. Therapeutic drug monitoring is required to ensure lithium levels remain in the therapeutic range: 0.6 or 0.8-1.2 mEq/L (or millimolar). Signs and symptoms of toxicity include nausea, vomiting, diarrhea, and ataxia. [3] The most common side effects are lethargy and weight gain. The less common side effects of using lithium are blurred vision, a slight tremble in the hands, and a feeling of being mildly ill. In general, these side effects occur in the first few weeks after commencing lithium treatment. These symptoms can often be improved by lowering the dose. [4]

Anticonvulsants [ edit ]

Many agents described as «mood stabilizers» are also categorized as anticonvulsants. The term «anticonvulsant mood stabilizers» is sometimes used to describe these as a class. [5] Although this group is also defined by effect rather than mechanism, there is at least a preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders. [ citation needed ]

Valproate – Available in extended release form. This drug can be very irritating to the stomach, especially when taken as a free acid. Liver function and CBC should be monitored. [6]
Lamotrigine (aka Lamictal) – FDA approved for bipolar disorder maintenance therapy, not for acute mood problems like depression or mania/hypomania. [7] The usual target dose is 100–200 mg daily, titrated to by 25 mg increments every 2 weeks. [8] Lamotrigine can cause Stevens–Johnson syndrome, a very rare but potentially fatal skin condition. [7]
Carbamazepine – FDA approved for the treatment of acute manic or mixed (i.e., both depressed and manic mood features) episodes in people with bipolar disorder type I. [9] Carbamazepine can rarely cause a dangerous decrease in neutrophils, a type of white blood cell, called agranulocytosis. [9] It interacts with many medications, including other mood stabilizers (e.g. lamotrigine) and antipsychotics (e.g. quetiapine). [9]

There is insufficient evidence to support the use of various other anticonvulsants, such as gabapentin and topiramate, as mood stabilizers. [10]

Antipsychotics [ edit ]

Some atypical antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone) also have mood stabilizing effects [11] and are thus commonly prescribed even when psychotic symptoms are absent. [11]

Other [ edit ]

It is also conjectured that omega-3 fatty acids may have a mood stabilizing effect. [12] Compared with placebo, omega-3 fatty acids appear better able to augment known mood stabilizers in reducing depressive (but perhaps not manic) symptoms of bipolar disorder; additional trials would be needed to establish the effects of omega-3 fatty acids alone. [13]
It is known that even subclinical hypothyroidism can blunt a patient’s response to both mood stabilizers and antidepressants. Furthermore, preliminary research into the use of thyroid augmentation in patients with refractory and rapid-cycling bipolar disorder has been positive, showing a slowing in cycle frequency and reduction in symptoms. Most studies have been conducted on an open-label basis. One large, controlled study of 300 mcg daily dose of levothyroxine (T4) found it superior to placebo for this purpose. In general, studies have shown T4 to be well tolerated and to show efficacy even in patients without overt hypothyroidism. [14]

Combination therapy [ edit ]

In routine practice, monotherapy is often not sufficiently effective for acute and/or maintenance therapy and thus most patients are given combination therapies. [15] Combination therapy (atypical antipsychotic with lithium or valproate) shows better efficacy over monotherapy in the manic phase in terms of efficacy and prevention of relapse. [15] However, side effects are more frequent and discontinuation rates due to adverse events are higher with combination therapy than with monotherapy. [15]

Relationship to antidepressants [ edit ]

Most mood stabilizers are primarily antimanic agents, meaning that they are effective at treating mania and mood cycling and shifting, but are not effective at treating acute depression. The principal exceptions to that rule, because they treat both manic and depressive symptoms, are lamotrigine, lithium carbonate, olanzapine and quetiapine. [ citation needed ]

Nevertheless, antidepressants are still often prescribed in addition to mood stabilizers during depressive phases. This brings some risks, however, as antidepressants can induce mania, [16] psychosis, [17] and other disturbing problems in people with bipolar disorder—in particular, when taken alone. The risk of antidepressant-induced mania when given to patients concomitantly on antimanic agents is not known for certain but may still exist. [18] The majority of antidepressants appear ineffective in treating bipolar depression. [18]

Antidepressants cause several risks when given to bipolar patients. They are ineffective in treating acute bipolar depression, preventing relapse, and can cause rapid cycling. Studies have shown that antidepressants have no benefit versus a placebo or other treatment. Antidepressants can also lead to a higher rate of non-lethal suicidal behavior. Relapse can also be related to treatment with antidepressants. This is less likely to occur if a mood stabilizer is combined with an antidepressant, rather than an antidepressant being used alone. Evidence from previous studies shows that rapid cycling is linked to use of antidepressants. Rapid cycling is defined as the presence of four or more mood episodes within a year’s time. Evidence suggests that rapid cycling and mixed symptoms have become more common since antidepressant medication has come into widespread use. There is a need for caution when treating bipolar patients with antidepressant medication due to the risks that they pose. [ citation needed ]

Pharmacodynamics [ edit ]

The precise mechanism of action of lithium is still unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. Lithium is known to inhibit the enzyme GSK-3B. This improves the functioning of the circadian clock—which is thought to be often malfunctioning in people with bipolar disorder—and positively modulates gene transcription of brain-derived neurotrophic factor (BDNF). The resulting increase in neural plasticity may be central to lithium’s therapeutic effects. How lithium works in the human body is not completely understood, but its benefits are most likely related to its effects on electrolytes such as potassium, sodium, calcium and magnesium. [19]

All of the anticonvulsants routinely used to treat bipolar disorder are blockers of voltage-gated sodium channels, affecting the brain’s glutamate system. For valproic acid, carbamazepine and oxcarbazepine, however, their mood-stabilizing effects may be more related to effects on the GABAergic system. Lamotrigine is known to decrease the patient’s cortisol response to stress. [ citation needed ]

One possible downstream target of several mood stabilizers such as lithium, valproate, and carbamazepine is the arachidonic acid cascade. [20]

Recognizing and Getting Help for Mood Disorders

Everyone feels down from time to time. Work is busy. Your kids’ schedules are overwhelming. You’re not getting enough sleep, and you’d rather spend the day at home in your sweats in front of the TV. You can’t muster the energy to do the things you need to do or the things you want to do. We’ve all been there. How do you know if you’re just burned out — or if you’re actually depressed?

It can be hard to distinguish between a bad mood or exhaustion and actual depression because the symptoms can be similar. While the word «depression» often brings to mind images of extreme sadness or inactivity, the mood changes related to depression are often more subtle than that, especially for women. Plus, it tends to affect more women than men.

You don’t need to have extreme emotions to have depression or another mood disorder, says Karen Swartz, M.D., director of the clinical and education programs at the Johns Hopkins Mood Disorders Center . “People think of depression as sadness or crying. They think of bipolar disorder as the Hollywood version of ‘mania,’ which is fun, outrageous happiness,” she says.

But in reality, mood disorders aren’t that dramatic — fewer than 50 percent of depressed women even describe themselves as sad. And not knowing the signs of a mood disorder can lead women to go untreated for longer than they should.

So how do you decide if it’s time to get help? First, it’s important to know that there are several types of mood disorders.

Types of Mood Disorders

There are several common types of mood disorders, including:

Major depression : Characterized as having less than normal interest in regular activities and lacking energy and focus for at least two weeks. “This is an illness mainly of women,” Swartz says. Premenopausal women are the group most affected by major depression. Their risk is twice as high as it is for men — roughly 20 percent of women will have a depressive incident at some point in their lives, compared to 10 percent of men. Research also suggests that in some women, reproductive-related hormonal changes can raise the risk of having depression.
Dysthymia (chronic depression) : A chronic, low-grade depressed or irritable mood lasting for at least two years.
Bipolar disorder : Fewer than 1 percent of adults have bipolar disorder. This mood disorder is marked by periods of depression alternating with periods of mania or elevated mood.

All mood disorders tend to run in families, so your risk is higher if you have relatives with depression or bipolar disorder.

Symptoms of Mood Disorders

Because the effects of mood disorders can be easy to ignore, it’s important to be tuned in to small changes in how you feel. Common symptoms of mood disorders include:

Irritability, aggression or hostility
An ongoing sad, empty or anxious mood
Changes in appetite or weight
Changes in sleep patterns
Difficulty concentrating

These symptoms may be more intense and last longer than what you normally experience every now and then. For instance, they might interfere with your ability to work or to enjoy being with friends and family.

How to Get Help for a Mood Disorder

If you think you might have a mood disorder, Swartz recommends first bringing your concerns to your primary care provider. If you feel your doctor is not taking your symptoms seriously, ask to be referred to a psychiatric provider.

“It’s OK to ask your physician, ‘Are you comfortable with treating these illnesses, or would it be better to refer me to a specialist?’” Swartz suggests.

Typical treatments include antidepressants and cognitive behavioral therapy, a type of talk therapy that focuses on developing coping strategies and changing unhealthy thoughts and behaviors. Of the antidepressants, selective serotonin reuptake inhibitors (SSRIs) like escitalopram are most commonly prescribed. Many studies show that a mix of medication and therapy is the most effective way to treat mood disorders.

Proper sleep is also critical while being treated for a mood disorder, Swartz says. “Interrupted sleep can be a trigger for bipolar disorder and depression. Normalizing and protecting sleep is very important,” she says.

If you don’t notice mood improvement on medication right away, remember that it does get better. Most people need to be on a full dose of medication for up to eight weeks before seeing benefits.

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