Mood stabilizer

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by rapid and unstable mood shifts. The most common is bipolar disorder, where mood stabilizers suppress swings between mania and depression, and these drugs are also used in borderline personality disorder. Most mood stabilizers are anticonvulsants, with the important exception of lithium, which is the oldest and best known mood stabilizing drug.

• Lithium carbonate —- Lithium is the ‘classic’ mood stabilizer. The first Food and Drug Administration-approved mood stabilizer, and still popular in treatment. Therapeutic drug monitoring required. Monitor blood lithium levels (therapeutic range: 0.6 or 0.8-1.2 mEq/L) and look for signs and symptoms of toxicity (such as nausea, vomiting, diarrhea, ataxia). See also lithium orotate, another lithium salt.
• Valproic acid (Depakene^®), divalproex sodium (Depakote^®), and sodium valproate (Depacon^®) — Available in extended release form. Can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC should be monitored. Therapeutic drug monitoring is required.
• Lamotrigine (Lamictal^®) — Particularly effective for bipolar depression. Monitor for signs and symptoms of Stevens-Johnson syndrome, very rare but can be fatal.
• Carbamazepine (Tegretol^®) — CBC should be monitored; can lower white blood cell count. Therapeutic drug monitoring is required. Not FDA-approved for bipolar disorder, but widely used for many years.
• Gabapentin (Neurontin^®) — Not FDA approved for bipolar disorder. Recent scientific studies suggest it is not an effective treatment, however many psychiatrists continue to use it.
• Oxcarbazepine (Trileptal^®) — Not FDA approved for bipolar disorder.
• Topiramate (Topamax^®) — Not FDA approved for bipolar disorder.

Sometimes mood stabilizers are used in combination, such as lithium with one of the anticonvulsants.

Many atypical antipsychotics also have mood stabilizing effects and are thus commonly prescribed even when psychotic symptoms are absent. It is also conjectured that Omega-3 fatty acids may have a mood stabilizing effect. However, more research is needed to verify this (a multi-year study of this is now being carried out as of 2001).

Most mood stabilizers are effective at treating mania and mood cycling and shifting, but are not very effective at treating depression (with lamotrigine and lithium carbonate being exceptions). Often, an antidepressant is prescribed in addition to the mood stabilizer during depressive phases. However this brings some risks, as antidepressants can induce mania, psychosis, and other disturbing problems in bipolar patients, particularly when taken alone, but sometimes even when used with a mood stabilizer.

• ATC code N03
• Treatment of bipolar disorder

• Manic-Depressive Illness by Frederick K. Goodwin and Kay Redfield Jamison.

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