Mood Stabilizer Medications

Mood stabilizers are often prescribed to manage symptoms of mood disorders, such as manic or depressive episodes. More specifically, these medications may (Soreff, 2022):

•           Prevent the relapse of mania or depression
•           Level out or stabilize mood instability
•           Reduce the intensity of mania or depressive symptoms

Examples of mood stabilizer medications include (Nath & Gupta, 2021):

•           Lithium (Lithobid^®)
•           Valproic Acid (Depakene^®)
•           Carbamazepine (Tegretol^®)
•           Lamotrigine (Lamictal^®)
•           Lumateperone (Caplyta^®)
•           Olanzapine and Samidorphan (Lybalvi^®)

Lithium

Lithium is the preferred choice for treating recurring bipolar disorder. This drug is known to have significant anti-manic effects and is often used for bipolar disorder type I. Lithium has a narrow therapeutic index. This means that small differences in dosing or in blood concentration can lead to diminished benefits or, alternatively, adverse effects (Hedya et al., 2021).

Lithium must be taken daily and simultaneously each day if possible. This is to keep the amount of the medication in your blood at the same level. Skipping doses or stopping quickly can lead to poor outcomes.

Lithium Maintenance Treatment

Regular blood tests are an important part of treatment with lithium. This is to ensure that the dose used is safe and that a therapeutic level is achieved.

One challenge is that the necessary dose can change over time, for instance, as a person ages or changes body weight. Lithium treatment may need to be reassessed due to medical conditions (e.g., kidney disease) or the addition of certain other medications.

People taking lithium typically must ensure adequate and consistent hydration and avoid painkillers in the class of non-steroidal anti-inflammatory drugs (NSAIDs), which includes, for example, ibuprofen.

Side Effects of Lithium

Common side effects associated with lithium include (National Alliance on Mental Illness [NAMI], 2021c):

• Sedation or feeling weak
• Nausea
• Hand tremor
• Increased thirst and urination
• Cognitive slowing
• Weight gain

Other Mood Stabilizer Medications

The following medications are also used to treat bipolar-related symptoms.

Valproic Acid

Valproic acid is an effective mood stabilizer and is frequently prescribed for bipolar disorder. It is as effective as lithium in treating bipolar disorder and even better at treating rapid cycling bipolar disorder (Bond et al., 2010).

Valproic acid can generate similar side effects as those seen with lithium (i.e., sedation, weak feeling, nausea, tremor, and weight gain). In rare cases, valproic acid can cause stomach, intestinal, or pancreas issues. It has also been associated with liver dysfunction. This medication can also result in birth defects if taken during pregnancy (Medline Plus, 2021c).

As with lithium, it is essential and valuable to check blood levels of valproic acid periodically.

Lamotrigine

Lamotrigine is an anticonvulsant medication. It is used as a maintenance treatment for bipolar I disorder. Lamotrigine is often used to increase the amount of time between manic or depressive episodes. The medication is less effective for promoting recovery from a manic or depressive episode. Other medications are often used to help clients return to their baseline mood (MedlinePlus, 2021b).

Lamotrigine tends to have fewer side effects when compared to other mood stabilizers. However, one notable, severe side effect of lamotrigine is Stevens-Johnson Syndrome, a potentially fatal reaction that starts with a rash and can progress to multi-organ failure (Drugs.com, 2021).

Carbamazepine

Carbamazepine is a mood stabilizer indicated for the treatment of bipolar disorder. This medication is sometimes prescribed off-label (not approved for use by the FDA) for the management of psychiatric and behavioral symptoms related to dementia as well. Careful monitoring of this medication is required as carbamazepine can lower white blood cell count and sodium levels and impact liver, kidney, and thyroid function (NAMI, 2021a).

Recently Released Mood Stabilizers

Two new psychiatric medications used to treat bipolar disorder and related symptoms are lumateperone, and the combination of olanzapine and samidorphan in one presentation. It should be noted that there are other practical and unique bipolar medications (e.g., cariprazine or pimavanserin) that are not included in this series.

Lumateperone

Lumateperone is an atypical antipsychotic that was approved by the FDA in 2021 to help manage bipolar-related symptoms. The medication is indicated for the treatment of depressive episodes associated with bipolar spectrum disorders.

Importantly, lumateperone is also used to treat acute schizophrenia. It is also indicated for agitation in older adults diagnosed with dementia (Cooper, 2022; O’Brien, 2021).

Olanzapine and Samidorphan

This medication is a combined presentation of olanzapine and samidorphan. Samidorphan is currently not available independently of this preparation. The main purpose of combining these two medications is to attempt to counteract the often-prohibitive metabolic side effects related to olanzapine. As previously mentioned, olanzapine is an antipsychotic agent used for the treatment of schizophrenia.

Olanzapine is also used to treat bipolar disorder-related symptoms. Samidorphan inhibits opioid receptors, and one major benefit of this medication is that is not associated with weight gain, which is a common problem observed in those taking antipsychotic and/or mood stabilizer medications (Stewart, 2021).

Antipsychotic medications are categorized as either typical or atypical. The side effect profile highly influences the choice of antipsychotic. Antipsychotic medications also come in long-acting injectable forms and can be used for clients that have difficulties with treatment adherence.

Mood stabilizers prevent mood instability in bipolar disorder. In addition, some mood stabilizers are used to treat acute mood episodes, while others are used to prolong mood stability. Careful blood monitoring is required with this category of medication, particularly with lithium carbonate and valproic acid.