How do mood stabilizers work? Understanding the function, benefits, and potential drawbacks of these medications can help you make informed decisions about your treatment, or about the care of a family member.
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What Are Mood Stabilizers?
Before we address how do mood stabilizers work, it can be helpful to briefly review what these drugs are.
Mood stabilizers are a category of prescription medications that are typically used to treat people who have bipolar disorder. Some mood stabilizers are also sometimes used to help people who have posttraumatic stress disorder (PTSD), schizophrenia, schizoaffective disorder, and certain other mental health concerns.
Four commonly prescribed mood stabilizers are:
- Lithium: Lithium’s use in medical and psychiatric care dates to the mid-1800s, though the drug did not receive approval from the U.S. Food and Drug Administration (FDA) until 1970. In a mental health context, its most common use today involves people with bipolar disorder who have been experiencing either acute manic episodes or mixed episodes (which include dramatic swings from mania to major depression).
- Valproic acid: Also known as valproate or divalproex, valproic acid is an anticonvulsant that also has mood stabilizing effects. It was first synthesized in 1882, and it earned FDA approval in 1976, when it was authorized to treat seizures. As an off-label mood stabilizer, valproic acid is usually employed to treat manic episodes, impulsivity, and aggression.
- Carbamazepine: Like valproic acid, carbamazepine is also an anticonvulsant that can be used as a mood stabilizer, typically to ease acute manic or mixed episodes. It may also be used to treat people who have been experiencing certain symptoms of schizophrenia and schizoaffective disorder.
- Lamotrigine: Initially synthesized in the early 1980s, lamotrigine was approved by the FDA in 1994. As a mood stabilizer, it is often used to treat rapid-cycling depression among people who have bipolar disorder. Lamotrigine can also be effective as a long-term maintenance medication for bipolar I disorder, which is characterized by manic episodes.
How Do Mood Stabilizers Work?
Given the considerable length of time that some of these medications have been used, you might think that experts have developed a detailed understanding of how do mood stabilizers work. Surprisingly, this is not necessarily the case.
For example, even though lithium has been approved for use in the U.S. for more than 50 years, researchers have not yet determined exactly how this drug elicits the effects that it does.
Studies suggest that lithium use alters levels of several neurotransmitters, including dopamine, glutamate, and gamma-aminobutyric acid (GABA). This drug also appears to promote greater volume in areas of the brain such as the hippocampus, amygdala, and prefrontal cortex. But the mechanism through which lithium causes these changes has not yet been identified.
Valproic acid may affect GABA levels by impacting multiple enzymes that are involved with its synthesis and degradation. This mood stabilizer also seems to alter the functioning of N-methyl-D-aspartate (NMDA), which is a key receptor for an excitatory neurotransmitter called glutamate.
Carbamazepine also seems to limit glutamate activity, which can have a calming effect throughout a person’s central nervous system. Lamotrigine appears to act in a similar manner. However, as with lithium and valproic acid, questions remain about how, exactly, these mood stabilizers affect glutamate.
Are Mood Stabilizers Safe?
A common follow-on to questions about how mood stabilizers work is, “Are they safe?”
When a person takes a mood stabilizer as directed by the professional who prescribed it, the medication can be both safe and beneficial.
However, it is important to remember that mood stabilizers are powerful drugs that, even when used appropriately, can cause a variety of side effects. For example:
- Lithium’s side effects can include weight gain, tremors, sexual dysfunction, cognitive impairments, and a worsening of acne and psoriasis. Lithium use has also been linked to damage to the thyroid and parathyroid glands, as well as the kidneys.
- Valproic acid: The more common side effects of valproic acid include headaches, drowsiness, dizziness, ringing in the ears, and blurred vision. More extreme, but thankfully rare, side effects can include hallucinations, polycystic ovarian syndrome (POS), psychosis, suicidal ideations, and coma.
- Carbamazepine: Carbamazepine’s most common adverse effects include lightheadedness, nausea, and muscle control problems. Less common but more severe effects of carbamazepine use can include liver and kidney damage, suicidal ideation, confusion, and elevated risk of delirium among older patients.
- Lamotrigine: Lamotrigine use has been associated with several distressing effects, including disrupted menstruation, vision problems, nausea, anxiety, insomnia, and pain in the abdomen, chest, and back.
Before you take a mood stabilizer or any other prescription medication, it is important to discuss its benefits and potential drawbacks with your physician. You should also notify a member of your treatment team if you begin to develop any adverse effects.
Depending on the severity of these effects, your healthcare provider may adjust your dosage or switch you to a different medication.
Alternatives to Mood Stabilizers
For people who are receiving treatment for bipolar disorder or certain other complex mental health disorders, mood stabilizers are often just one of several elements of care. Instead of viewing these other elements as alternatives to mood stabilizers, it may be more appropriate to think of them as complementary services.
In addition to mood stabilizers, treatment for bipolar disorder may also include:
- Genetic testing
- Med Management with Psychiatrist
- Antidepressants
- Anti-anxiety (anxiolytic) meds
- Individual psychotherapy
- Group therapy sessions
- Family therapy and education
- Acceptance and commitment therapy (ACT)
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
This range of options underscores the importance of finding a treatment provider that will assess your needs, help you set appropriate goals, then develop a customized plan just for you.
For bipolar disorder and other complex mental health concerns, there is no perfect service or approach that works for everyone. What’s most important is finding the treatment that’s best for you.
Find Treatment for Bipolar Disorder in Atlanta
New View Wellness offers life-affirming outpatient care for adults or teens whose lives have been disrupted by bipolar disorder and other mental health concerns. We also provide dual diagnosis programming for patients whose mental health challenges are accompanied by co-occurring addiction.
When you choose our center, you can expect to receive customized care and compassionate support from a team of skilled and experienced professionals. We are committed to working closely with you to identify the therapies and support services that can ease your symptoms and empower you to live a much healthier and more hopeful life.
To learn more about how we can help you or a loved one, or to schedule a free assessment, please visit our Admissions page or call us today.
