Mood Stabilizers for Bipolar Disorder

Mood stabilizers are a type of medication used in the treatment of bipolar and other disorders. As the name suggests, mood stabilizers work to prevent both the extreme high and low moods associated with illnesses like bipolar disorder. Unlike other medications such as antidepressants, mood stabilizing medications do not induce cycling or mania.

Lithium – The First Mood Stabilizer

Lithium is the only true mood stabilizing medication. While other medications may be termed "mood stabilizers," lithium is the only drug technically of that class.

Lithium was the first compound approved by the Food and Drug Administration (FDA) for the treatment of bipolar disorder. Lithium is approved for use in bipolar mania and bipolar maintenance treatment; although it is frequently used to treat bipolar depression, often in combination with other medications. Lithium has an unparalleled antisuicidal property, shown to reduce the risk of attempted and completed suicides by 80%.¹

Lithium is still the first-choice mood stabilizing drug in many circumstances but blood levels must be constantly monitored to ensure the lithium level is high enough to be effective but not high enough to be toxic. Thyroid levels also must be carefully monitored as lithium can reduce thyroid levels.²

Anticonvulsants as Mood Stabilizers

Anticonvulsants used in the treatment of mood disorders are frequently also termed mood stabilizers. Anticonvulsants are actually medications designed to treat seizure disorders but some have shown to be effective mood stabilizers. Some anticonvulsant mood stabilizers have been shown to be particularly useful in treating bipolar depression and rapid-cycling bipolar disorder. The three most widely used anticonvulsant mood stabilizers are carbamazepine, valproate and lamotrigine.³

Carbamazepine

Carbamazepine (Tegretol) is often an effective mood-stabilizing medication in those who do not respond to lithium and has been shown to effectively treat rapid-cycling bipolar disorder. It is approved by the FDA for use in manic episodes and mixed bipolar episodes but it often used as a maintenance mood stabilizer.

Valproate

Valproate sodium (also valproic acid, divalproex sodium, brand name Depakote) is approved in the treatment of bipolar mania. Valproate is a mood stabilizing agent commonly combined with lithium or other medications to treat bipolar. Valproate has been shown effective in treating rapid-cycling bipolar disorder as well as aggressive or behavioral disorders.

Lamotrigine

Lamotrigine (Lamictal) is approved in the maintenance treatment of bipolar disorder but also appears to be the most effective anticonvulsant mood stabilizer for treating bipolar depression. Lamotrigine has the extremely rare side effect of the Stevens-Johnson syndrome. This skin rash is potentially fatal if left untreated. Lamotrigine is started at a low dose and the dose is increased very slowly to reduce the chance of a rash. Any rash that does occur should be reported to a doctor immediately. Most doctors will discontinue lamotrigine at the first sign of a rash due to the possible risk but the vast majority of rashes are not of the Stevens-Johnson type.

Other Anticonvulsant Mood Stabilizers

While there are no other FDA-approved anticonvulsant mood stabilizers, other anticonvulsant medications are often used off-label. Other anticonvulsants used in stabilizing mood are:

• Oxcarbazepine (Trileptal)
• Topiramate (Topamax)
• Gabapentin (Neurontin)

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