Mood stabilizers explained

What mood stabilizers are

Mood stabilizers are medications used to even out mood and to prevent the highs and lows of bipolar disorder. They are a mixed group rather than a single type of drug.

The main ones are lithium, which is the oldest and still a benchmark, and several anticonvulsant medications used for mood: lamotrigine (Lamictal), valproate, also called divalproex (Depakote), and carbamazepine (Tegretol). Some atypical antipsychotic medications are also used to stabilize mood, but they are usually grouped separately.

How they work

How mood stabilizers work varies across the group. Lithium is a naturally occurring element, and the way it stabilizes mood is still not fully understood. The anticonvulsants in the group calm excessive nerve signaling. The full picture of how any of these medications steady mood is not known.

What they are used for

Mood stabilizers are used mainly for bipolar disorder. They are used both to treat acute mood episodes and, importantly, to prevent future episodes over the long term. Preventing future episodes is called maintenance treatment, and it is a central reason these medications are taken.

Lithium also has evidence for reducing the risk of suicide. Some mood stabilizers are also added to an antidepressant in depression that has been hard to treat.

What they have in common

The medications in this group share several things.

• They are long-term maintenance medications, taken to prevent episodes over time.
• They need a careful approach to dosing.
• Several of them require blood tests, both to check medication levels and to monitor organs.
• Stopping them abruptly can destabilize mood, so they need a gradual, planned taper.

How they differ from each other

The mood stabilizers are not interchangeable. A few differences shape the choice.

• Lithium. It has strong evidence behind it, but it needs regular blood tests. It has a narrow range between an effective dose and too much, and it needs kidney and thyroid monitoring.
• Lamotrigine. It is particularly good at preventing the depressive episodes of bipolar disorder. It needs a slow, careful dose increase because of a rare serious rash risk, and it is relatively weight-neutral.
• Valproate. It is effective for mania and needs monitoring. It can cause weight gain. It is generally avoided in pregnancy and in people who could become pregnant, because of a risk of birth defects.
• Carbamazepine. It is effective but interacts with many other medications.

A note on diagnosis

An accurate bipolar diagnosis matters. Mood stabilizers are central to treating bipolar disorder, and an antidepressant taken alone can sometimes destabilize mood in someone who has bipolar disorder. Getting the diagnosis right shapes which treatment is the right one.

The medications in this group

• Lithium. The oldest mood stabilizer and still a benchmark. It needs regular blood tests and kidney and thyroid monitoring, and it has evidence for reducing the risk of suicide.
• Lamotrigine (Lamictal). A mood stabilizer that is particularly good at preventing depressive episodes. It needs a slow dose increase and is relatively weight-neutral.
• Valproate (divalproex, Depakote). An effective treatment for mania that needs monitoring, can cause weight gain, and is generally avoided in pregnancy.
• Carbamazepine (Tegretol). An effective mood stabilizer that interacts with many other medications.

PsychiatryRx has a dedicated guide for lamotrigine, with more detail on its uses, side effects, dosing, and what to expect.

Sources

This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.

1. U.S. Food and Drug Administration. Prescribing information.
2. MedlinePlus, U.S. National Library of Medicine.
3. National Institute of Mental Health. Mental health medications.