What Are Mood Stabilizers?

Mood stabilizers are psychiatric pharmaceutical medications prescribed to help control the mood swings present in various mental disorders. These medications control the severity of the highs and lows experienced by restoring the chemical balance in the brain.

Most commonly, mood stabilizers are used to treat those with bipolar disorder. However, they can also be used to treat those with schizoaffective disorder, borderline personality disorder (BPD), and in some instances, depression.

Types of Mood Stabilizers

There are currently three main types of drug classes used as mood stabilizers in the United States for various conditions.

Mineral (Lithium)

Lithium is an element that occurs naturally in the world — it is third on the periodic table. It was first discovered in Australian and Chilean mines in 1817. However, it would only have its mood-stabilizing effects recognized later in the century, and its usage would only be approved by the U.S. Food and Drug Administration (FDA) in 1970.

The exact mechanism of how lithium works as a mood stabilizer is not yet fully known. However, research has suggested that it has to do with targeting the activity of specific enzymes within the neuron. This has the overall impact of decreasing abnormal activity in the brain and is known to reduce suicidal behaviors.

Lithium’s most recognized brand names include Eskalith, Lithobid, and Lithonate.

Common side effects of lithium include increased thirst and urination, headaches, nausea, diarrhea, dizziness or drowsiness, and changes in appetite. However, with continual usage, some of these may decrease in severity.

Anticonvulsants

Certain anticonvulsants, also referred to as anti-seizure medications, are also used as mood stabilizers. Although they were initially used to treat epilepsy, they were found helpful in treating bipolar disorder due to their ability to calm hyperactivity in the brain.

The most widely known anticonvulsants used as mood stabilizers include:

• Depakote (valproic acid)
• Lamictal (lamotrigine)
• Tegretol or Equetro (carbamazepine)
• Neurontin (gabapentin)
• Topamax (topiramate)
• Trileptil (oxcarbazepine)
• Gabitril (tiagabine)

While Depakote and Tegretol are particularly useful in treating mania, Lamictal has been found to be more effective at treating and preventing depressive symptoms in bipolar disorder. Nevertheless, they’re all found to be very useful in helping to stabilize moods overall.

Anticonvulsant side effects vary depending on the particular agent. Common side effects may include headaches, dry mouth, dizziness and drowsiness, fatigue, and weight gain. However, these may also lessen over time with continual use.

Antipsychotics

For those with bipolar disorder, acute episodes of mania can result in psychosis in up to 53% of individuals. Due to this, antipsychotics are often prescribed for the acute treatment of mania. In addition, the newer category of "atypical" antipsychotics also have mood-stabilizing properties of their own.

The most commonly used antipsychotics for this purpose include:

• Abilify (aripiprazole)
• Geodon (ziprasidone)
• Latuda (lurasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)
  

While atypical antipsychotics are much less likely to cause extrapyramidal side effects (stiffness, tremor, shuffling gate, fixed gaze) than the earlier generation of antipsychotics, they are known to cause other side effects such as drowsiness, blurred vision, weight gain, and metabolic problems.

How They Work

It is not precisely known how these medications stabilize an individual’s mood. These agents have been found to impact various functions within nerve cells in the brain. This includes modulating enzymes and impacting ion channels, cell membranes, proteins, and receptors.

In turn, these agents influence the excitatory effects of the neurotransmitter glutamate and the inhibitory effect of GABA. It is hypothesized that long-term changes in gene expression, protein concentration, and protein phosphorylation may be the underlying reason for the mood-stabilizing effects of these medications.

In summary, it's complicated.

Conditions Used For

Mood stabilizers are usually used to treat the following conditions:

Bipolar Disorder:

This is the most common use for mood stabilizers and the area where most research into their use is found. As a result, they are commonly prescribed and are an essential aspect of treatment for bipolar disorder. Responses to different types vary from person to person, so various treatment plans are individualized.

Mood stablizers can treat mood episodes and be used for maintenance treatment to prevent the recurrence of these episodes. When combined with coping strategies, healthy lifestyle choices, and therapy, many individuals find their symptoms significantly lessen in severity.

Schizoaffective Disorder:

Schizoaffective disorder is a chronic mental health condition where individuals experience a combination of psychosis symptoms (hallucinations and delusions) and mood disorder symptoms (mania, hypomania, and/or depression). Mood stabilizers have been found effective at stabilizing and preventing the highs and lows experienced by individuals who fall under the bipolar subtype specifier for schizoaffective disorder.

Borderline Personality Disorder:

Mood stabilizers have been used for those experiencing emotional dysregulation and impulsivity.

Side Effects

Each type of mood stabilizer has its own unique side effects that vary from person to person. Here are some common side effects you can experience:

• Headaches
• Nausea
• Vomiting
• Dizziness
• Constipation
• Diarrhea
• Weight gain or loss
• Dry mouth
• Fatigue

Warnings and Interactions

Those who take lithium regularly can sometimes experience a serious condition called lithium toxicity. The kidneys usually excrete lithium; however, the concentration can rise should this mechanism fail or the intake increases excessively.

In most cases, the signs of this toxicity are easily identified and managed. In addition, healthcare providers regularly monitor lithium concentration levels through routine blood tests.

It is also recommended that those taking lithium ensure they are hydrated to maintain a healthy blood serum level. Long-term lithium usage can also result in chronic kidney disease and thyroid abnormalities, so healthcare providers will also check kidney and thyroid function in conjunction with treatment.

Other mood stabilizers like Tegretol and Depakote also require blood level testing to ensure the serum level remains at a steady concentration. Liver functions and blood counts are generally monitored when using these medications. It is also advised that individuals limit their alcohol usage when using these types of medication due to their ability to increase its effect.

It is also important to note that all antipsychotics carry a Black box warning due to their association with increased mortality in elderly patients with dementia.