Mood stabilizers are the breakthrough I didn’t realize I needed. After a lifetime of undiagnosed and untreated bipolar disorder II, I was surprised to discover a wealth of options for bipolar patients seeking medication management. 

So, when I received my diagnosis, my psychiatrist prescribed a mood stabilizer to bring me out of an intense depressive state that had become debilitating. And, I’ll confess I was scared and intimidated regarding how this medication would affect me. 

The societal stigma of mental illness contributes to the negative opinion, shame, and fear of psychiatric drugs. Mood stabilizers are one class of medication that has received a bad wrap. 

The stigmatization of mood stabilizers is unfortunate, considering that under the care of a qualified psychiatrist, these medications effectively treat mental illness and improve the quality of life for many patients.

 What has society gotten wrong about mood stabilizers? And, what role do they play in the treatment of bipolar disorder?

What Are Mood Stabilizers?

Similar to their name, mood stabilizers are a type of medication that stabilizes mood for bipolar patients. However, a common misconception about mood stabilizers is that they prevent one from experiencing the range of emotions and feelings associated with daily life. 

What’s more, many people inaccurately believe you become numb, zoned out, and “zombie-like” when prescribed mood stabilizers.

 But, this is far from true. In reality, mood stabilizers decrease the peaks and valleys of bipolar known as mania/hypomania, mixed states, and depression. 

These extreme “moods” result in significant behavioral and cognitive changes that alter your perception and actions.

Additionally, these “moods” don’t fluctuate or change within a day. Instead, they’re consistent and last for some time, so mood stabilizers are perfect for calming these extremes and essential for balance.

Furthermore, when you work with a qualified psychiatrist that understands psychiatric disorders such as bipolar, they’re equipped to build your tolerance to your medication(known as titration) until you find that symptoms resolve and you reach a state of equilibrium.

What’s Considered A Mood Stabilizer?

Mood stabilizers vary due to class and what bipolar symptoms they treat. Minerals, anticonvulsants, and antipsychotics are the mood stabilizers that psychiatrists prescribe to bipolar patients.

Lithium Carbonate (Brand Name: Eskalith)

Apart from being a popular Nirvana song, Lithium is a naturally occurring mineral produced in your body. Therefore, it’s considered the GOLD STANDARD treatment for bipolar disorder, especially atypical cases. 

In addition to its efficacy, Lithium is a successful antimanic agent making it the preferred treatment when treating acute episodes of mania. Lastly, it’s a favorite among psychiatrists because of its antisuicide effects.

You must work with your medical team (PCP and Psychiatrist) to monitor lithium blood levels, medical condition, and response to treatment. 

Additionally, reporting side effects, especially adverse side effects, is essential feedback your psychiatrist needs to either adjust your dosage or determine if it’s the correct medication for you.

Less severe side effects of Lithium Carbonate are:

• Dizziness
• Low energy levels
• Muscle tremors
• Increased thirst
• Nausea
• Vomiting
• Diarrhea
• Involuntary urine leakage
• Frequent urination

Less common side effects include:

• Diabetes
• High white blood count
• Fainting
• Constipation
• Skin inflammation
• Acne
• Muscle weakness
• Taste impairment
• Reduced muscle coordination
• Skin rash
• Water retention

Typically, these symptoms decrease as your body becomes more tolerant of the medication. However, in the event these symptoms worsen, speak with your treatment team to discuss alternative options.

Rare side effects to monitor are:

• Hyperthyroid
• Low thyroid levels
• Abnormal electrical heart signals
• Decreased heartbeat
• Low blood pressure
• Nephrotic syndrome (type of kidney disorder)
• Seizures
• Hallucinations
• Angioedema

There are additional side effects that you should discuss with your psychiatrist to know the risks of taking this medication. If you choose this medication, record your symptoms and discuss them with your psychiatrist at follow-up appointments.

Anticonvulsants

Initially, anticonvulsants were created to treat seizures for epileptic patients. However, the FDA approved them to treat bipolar symptoms. Additionally, these medications provide an alternative to Lithium Carbonate and effectively treat depressive episodes more common for bipolar II patients. 

There are a variety of anticonvulsant medications on the market. These medications include Lamotrigine (Lamictal), Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), Divalproex sodium (Depakote), and Valproic acid (Depakene). Generally, psychiatrists prescribe these medications the most. 

However, as with all medications, there are side effects and risks involved. For example, various anticonvulsants can cause liver and kidney complications with prolonged use. 

In addition, they can interact with other drugs and supplements, contributing to adverse reactions. 

Furthermore, psychiatrists will avoid prescribing anticonvulsants to pregnant women and women seeking to become pregnant due to the increased risk of congenital disabilities. 

Therefore, your treatment team should monitor your physiological health with regular blood work and discuss any adverse symptoms you may be experiencing. 

Additionally, you should discuss new drugs and supplements with your PCP, psychiatrist, and pharmacist to prevent potential problems.

Each brand of anticonvulsant will have unique side effects. However, anticonvulsants share many of the same side effects.

Common side effects include:

• Dizziness
• Drowsiness
• Fatigue
• Nausea
• Tremor
• Rash
• Weight gain
• Abnormal bruising
• Vision complications
• Light sensitivity
• Tremor
• Headache
• Confusion
• Decreased libido
• Increased risk of chronic kidney disease (CKD)
• Liver complications
• Suicidal thoughts
• Worsening depression
• High blood pressure
• Sjogren’s Syndrome

As mentioned prior, your psychiatrist must disclose all potential side effects and complications associated with any medication you take for bipolar treatment. Furthermore, open communication about new or worsening symptoms and tracking your symptoms can help prevent serious complications.

Antipsychotics

Although not considered a mood stabilizer, antipsychotics can treat bipolar symptoms and play well with mood stabilizers. Therefore, psychiatrists prescribe them to treat acute manic episodes, especially bipolar patients with psychotic symptoms. In various cases, doctors may decide to combine an antipsychotic with an anticonvulsant or lithium, especially during acute manic episodes. 

Additionally, psychiatrists may prescribe an antipsychotic as a standalone treatment. 

As shared in The Psychiatric Times, the article discusses a study listing Quetiapine, Olanzapine, and Aripiprazole as FDA-approved standalone treatments for bipolar disorder. However, Quetiapine reigns supreme when treating acute depressive episodes, while Olanzapine and Aripiprazole do not. Nonetheless, these antipsychotics can act as ideal maintenance treatments for bipolar symptoms.

Commonly prescribed antipsychotics are Haloperidol (Haldol), Loxapine (Loxitane), Loxapine inhaled (Adasuve), Risperidone (Risperdal), Aripiprazole (Abilify), Asenapine (Saphris), Ciprazine (Vraylar), Lurasidone (Latuda), Olanzapine (Zyprexa), Olanzapine/samidorphan (Lybalvi), Quetiapine fumarate (Seroquel), Ziprasidone (Geodon).

As with all medications, there are side effects associated with antipsychotics; these include but are not limited to:

• Dizziness
• Drowsiness
• Restlessness
• Weight gain
• Dry mouth
• Constipation
• Nausea
• Vomiting
• Blurred vision
• Low blood pressure
• Tics and tremors
• Seizures
• Decreased white blood cell count

If your doctor considers an antipsychotic as a potential treatment for your bipolar, make sure they discuss the benefits, side effects, and possible complications of the medication they’re prescribing.

What’s The Best Mood Stabilizer for Bipolar?

The best mood stabilizer is the one that works for you, and this will vary from person to person. Furthermore, it’s important to remember that mood stabilizers are not a cure for bipolar. 

They effectively decrease symptoms and improve quality of life but do not replace lifestyle changes and therapy. However, there is a process involved with determining the efficacy of your mood stabilizer.

First, educate yourself on the mood stabilizer you’re prescribed. What are the specific side effects associated with the mood stabilizer your psychiatrist is recommending?  When is the best time for you to take it? Will you experience drowsiness or fatigue that could impact driving or operating machinery? 

Is it recommended that you eat food with your medication?  And do you need to be made aware of adverse complications?  If you have a pre-existing condition, is this medication appropriate for you?  How often will your psychiatrist monitor your blood work to check for adverse reactions? 

I encourage you to ask your psychiatrist these questions and enlist the help of your PCP and pharmacist. Speak with them about the potential side effects of these medications and determine what an appropriate schedule for blood testing would look like and critical signs and symptoms that indicate severe reactions. 

Finally, you need to know which medications and supplements do not work well with your mood stabilizer. Therefore, talking with your pharmacist and requesting a list of medicine and supplements will prevent complications. 

Consequently, creating a medical team in which your PCP, psychiatrist, and pharmacist work together will benefit your health holistically. 

I highly recommend you journal and track your moods, emotions, thoughts, and side effects. Doing so makes it easier to identify when to reach out to your medical team to make necessary changes. 

Advocating for your mental health and wellness is essential when undergoing medication management. In addition, self-advocacy ensures you’re receiving safe and effective treatment.

Are Mood Stabilizers Good For Bipolar?

Many of us with bipolar ask whether mood stabilizers are effective treatments. And, there isn’t an easy answer since bipolar is different for each individual. But, experiencing unpleasant side effects is the main reason many discontinue treatment. Therefore, making it challenging to find an appropriate medication.

In my case, mood stabilizers are beneficial for treating my bipolar symptoms but come with nasty side effects that clash with my pre-existing health conditions.  But, I will say that not struggling with the intense ups and downs of bipolar makes fighting to find a suitable treatment worth it.

Living with untreated and undiagnosed bipolar for most of my adult life led to many personal struggles, especially depressive episodes. My depression could last for weeks or months and cause me to become detached from reality. 

As a result, I struggled with suicidal ideation, intense anxiety, panic attacks, and multiple mental breakdowns. And, since I have rapid cycling bipolar II, I rarely get a break in between hypomanic and depressive episodes. 

However, taking a mood stabilizer decreased the intensity of hypomanic and depressive episodes. Which, in turn, provided much relief and increased stability in my life.

But, many don’t respond well to bipolar medication because the side effects are too much, and they don’t respond well to treatment. Other patients don’t like the idea of taking medication and look for alternative avenues to manage their bipolar. 

Whether mood stabilizers are “good” for bipolar is a personal decision to make under a medical professional and qualified therapist.

The bottom line is mood stabilizers are an essential tool in bipolar treatment. While there are risks and complications associated with mood stabilizers, the benefits outweigh the risks for many. 

Engaging in independent research and discussing your proposed treatment plan with your psychiatrist and PCP should be the determining factor as to whether mood stabilizers are appropriate for you.

Suppose you decide to pursue treatment creating a care team composed of your psychiatrist, PCP, and pharmacist. Doing so will ensure that you’re receiving the best treatment that decreases symptoms, has the least number of side effects, and has no adverse reactions and complications. With proper execution, mood stabilizers have proven to adequately treat and improve the quality of life and reduce symptoms.