Mood stabilizers: Uses, common brands, and safety info

Bipolar disorder, in all of its forms, is one of the most common health conditions; it affects more than 1 in 25 Americans at some point in their life, according to a National Institute of Mental Health survey. The magnitude of bipolar’s extent is shocking to many. The social stigma of the disease often keeps people from discussing their condition, and so we naturally underestimate the prevalence of bipolar disorder. Raising awareness and seeking medical attention when needed is absolutely essential, considering that medications termed “mood stabilizers” can effectively treat bipolar disorder. Use this guide to mood stabilizers to better understand their potential benefits, risks, and costs.

What are mood stabilizers?

Mood stabilizers are used to achieve and maintain relief of bipolar disorder symptoms. The mental states that typify bipolar are mania and hypomania. 

Manic episodes usually involve an elevated mood and energy, along with pressured speech, less need for sleep, inflated self-esteem, rapidly changing ideas, racing thoughts, risk-taking behavior, and increased positive or negative goal-directed activity (working exceptionally hard at work or toward something destructive). Not all of these symptoms of mania are present in each case. Hypomanic spells have similar features but are typically less intense, interfere less with functioning, and may only last a few days.

At the opposite pole of the mood spectrum is depression with its lack of motivation or sadness. Most individuals with bipolar disorder experience depression at some point. Sometimes, rapid cycling back and forth between episodes of mania and depression can occur.

Mood stabilizers can effectively stop an acutely dangerous manic state that has put the person’s safety at immediate risk from dangerous activities or suicide. Once relief is gained from the mania or hypomania, these same medications can help prevent recurrences. Most mood stabilizers can also treat bipolar depressive episodes as well.

RELATED: List of antidepressants

How do mood stabilizers work?

Mood stabilizers come from different drug categories but they work similarly to bring someone out of a manic or depressive state. Reducing or elevating certain brain cell activity is a probable common mode of action. This may be achieved by altering the action of brain chemicals like dopamine and serotonin. The outcome is that manic moods are suppressed and depressed moods are elevated and, with continued use, a normal, neutral mood can be maintained.

What are mood stabilizers used for?

Mood stabilizers are used to treat the following mood disorders:

• Bipolar mania

• Bipolar hypomania

• Bipolar depression

• Maintenance treatment of bipolar disorder

RELATED: Borderline personality disorder vs. bipolar disorder

Types of mood stabilizers

Lithium

Lithium has been used in the treatment of bipolar disorder for more than 70 years. The long-standing, successful use of this elemental substance has made it the standard to which other bipolar medications are compared. It is used to achieve remission from mania and maintain it. Despite lithium’s extensive history, its mechanism remains a mystery. 

Antiepileptics or anticonvulsants

Anticonvulsant medications are used in a number of ways medicinally, including as mood stabilizers. Depakote is used as a first-line agent used to treat acute mania and prevent recurrences, and Tegretol and Lamictal have situational use as well. Their mechanism seems to be related to sodium channel changes that lessen certain brain cell activity.

RELATED: Depakote side effects

Antipsychotics

This drug class gets its name from an ability to also treat delusions, paranoia, and hallucinations, in conditions like schizophrenia. They are, however, quite useful for mood problems as well. The antipsychotics are often used in combination with lithium or valproic acid for the treatment of mania and used alone for hypomania and bipolar depression. These medications block the receptors for dopamine and serotonin, which are substances that brain cells use to signal one another. 

Haldol is a classic example of a first-generation antipsychotic, which is still in use but largely replaced by second-generation antipsychotics such as Seroquel, Zyprexa, Abilify, Risperdal, and Latuda. The newer options may be less likely to cause abnormal movements.

RELATED: What are antipsychotics?

Who can take mood stabilizers?

Adults can take mood stabilizers, with the standard caveat that the choice between drug options is typically dictated by potential side effects.

Women with bipolar disorder who could become pregnant often avoid Depakote, Tegretol, and lithium. These drugs pose more risk to a fetus.

Can children take mood stabilizers?

Atypical antipsychotics (second-generation) are typically the preferred treatment of bipolar disorder in children because of lesser side effect concerns. If they do not work, lithium is a second choice, and antiepileptics are the last option.

Can seniors take mood stabilizers?

The usual medications for bipolar mania, hypomania, and depression are used in seniors. Unfortunately, this age group carries a higher likelihood of other medical conditions and more concurrent medications that could create additive problems when used alongside mood stabilizers. These concerns mean that more cautious dosing and more careful monitoring for adverse effects is necessary.

Are mood stabilizers safe?

Black box warnings

A number of the FDA’s strongest warnings exist for members of the mood stabilizer class, including the following: 

• Close monitoring is needed for the effects of lithium.

• Depakote can cause severe reactions within the liver or pancreas and poses a significant risk during pregnancy. 

• Serious skin and bone marrow complications can occur with Tegretol. 

• The warnings for antipsychotics include heightened suicide risk, particularly in children, and higher mortality in seniors with dementia.

Recalls

No recalls are currently active for the most common mood stabilizers but the FDA website can be searched for updates.

Restrictions

A history of hypersensitivity to a mood stabilizer precludes the use of that agent or closely related drugs again. A number of situations call for particular caution with antipsychotics, including:

• Diabetes

• Dehydration

• Alcohol use

• Difficulty urinating or with bowel movements

• Seizure risk

• Suicide risk

• Glaucoma

• Heart rhythm problems

• Low blood cell counts

Lithium use is more concerning for some individuals, such as those with dehydration, reduced kidney function, heart problems, and alcohol use. 

Specifically for valproic acid, caution is advisable in settings such as liver disease, kidney problems, reduced blood cell counts, bleeding risk, and head injuries. 

Carbamazepine warrants caution with diseases of the heart, liver, and bone marrow.

Can you take mood stabilizers while pregnant or breastfeeding?

Antipsychotics can be utilized during pregnancy and breastfeeding if the possibility of side effects is understood. If lithium is used in pregnancy, close monitoring of levels and the fetus is advisable, and in breastfeeding, lithium may best be avoided. Valproic acid and carbamazepine have considerable risks in pregnancy and are avoided if possible, but they are more commonly used during breastfeeding if monitoring is conducted. 

Are mood stabilizers controlled substances?

The DEA list of controlled substances does not include the common mood stabilizers.

Common mood stabilizers side effects

The following are common side effects across mood stabilizers but adverse reactions may vary by medication:

• Heart problems or high blood pressure

• Thyroid or parathyroid problems

• Diarrhea, nausea, or vomiting

• Weight gain or swelling

• Mental impairment or drowsiness

• Suicidality

• Low sodium or potassium levels

• Liver, pancreas, or kidney problems

• Parkinson-like symptoms (tremor, unsteadiness, or slowness of movement)

• Vision problems

• Serious skin and immune reactions

• Diabetes mellitus

• Seizures, stroke, speech and swallowing difficulties, or memory problems

• Body temperature disturbances

• Cough

How much do mood stabilizers cost?

The expense of mood stabilizers can range from $30 for a one-month supply of lithium tablets to more than $2,000 for Latuda tablets for a month. Typically, brand-name medications cost more than generic drugs. No matter the cost, a SingleCare discount card may help you save money on mood stabilizers and other prescriptions.