Mood stabilizers are a special category of medications used to treat people struggling primarily with bipolar mood disorder, borderline personality disorder (BPD), and schizoaffective disorder. Sometimes, they are also used in supplementation to other medicines, like antidepressants.

Medicines, like mood stabilizers, can help in the cessation of serious mood swings, a distinguishing characteristic of bipolar disorder. However, use of these may also lead to serious side effects. A person suffering from bipolar disorder may experience a myriad of changes in terms of:

  • Mood
  • Energy levels
  • Activity levels
  • Changes in the ability to perform everyday tasks

Although there are various types of bipolar disorder, almost all of them are characterized by a significant shift in mood which can vary greatly in duration and intensity. These mood swings could be manifested as manic episodes, during which a person feels highly energized and vivacious, and depressive episodes, during which the patient may feel dejected and lethargic.

Mood stabilizers are used for the immediate suggestive resolution of manic and depressive episodes. These also help prevent the development of these symptoms in the future. It is worthwhile to note that some mood stabilizers are efficacious in managing depressive episodes while others are better at managing the manic episodes. A doctor may prescribe a mood stabilizer either on its own or in combination with other drugs but it is important to understand that the treatment with mood stabilizers is one part of the management of bipolar disorder as the latter is also managed with psychotherapy.

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Classification of Mood Stabilizers

Mood stabilizers have evolved with ongoing research to become better and more effective and with each stage of evolution, these were classified for better management. Below is a brief timeline of their evolution and classification:

  • In the 1960s, researchers developed the first generation of mood stabilizers which included drugs like lithium, carbamazepine, and valproate.
  • In the early 1990s, researchers came up with the second generation of mood stabilizers known as atypical antipsychotic drugs which possessed mood-stabilizing effects. This classification included drugs like olanzapine, quetiapine, aripiprazole, and risperidone.
  • In 1994, the Food and Drug Administration (FDA) approved lamotrigine, an anticonvulsant drug, to be used as a mood stabilizer for people struggling with bipolar disorder as well as for epilepsy.

First generation mood stabilizers

Here, we discuss the different mood stabilizers, their mode of action, use, and side effects.

  • Lithium: One of the most widely prescribed medicinal agents for the management of bipolar disorder is lithium as it has demonstrated a steep decline in suicidal cases. It is also used as an augmentation agent, administered concurrently with antidepressants to which a patient has had a milder response for the management of major depressive disorder (MDD). Incidentally, lithium can also prevent the occurrence of cluster headaches and chronic daily headaches. However, it possesses a narrow window for both toxicity and benefit, making it indispensable to continuously monitor the serum levels of the user. Even a few extra doses than the scheduled amount can prove to be lethal. Lithium also affects the kidney and the thyroid gland, making it imperative to keep a watch on their functions as well.
  • Carbamazepine: An antiepileptic agent used for the treatment of generalized and partial seizures. It is a famous mood stabilizer and is used as a gold standard of treatment for managing trigeminal neuralgia and neuropathic stabbing pain. This medication can also have grave side effects like agranulocytosis (lowered white blood cell count), rashes, and aplastic anemia, thus regular laboratory screening among its user is imperative. Carbamazepine is also known to interact with other medicines therefore it must be taken under strict medical supervision.
  • Valproate: A FDA approved drug used for the management of acute bipolar mania in grown-ups. Emerging evidence has established its efficacy in the management of acute mania in the young population and also as an imperative part of maintenance treatment of BPD. Valproate may be especially useful in patients struggling with cyclothymia, mixed and rapid cycling, panic disorder, post-traumatic stress disorder (PTSD), seizure disorder, developmental disability, and BPD with concomitant diagnosis of migraines. It can induce lethal hepatic failure in young patients of two years and in the initial six months of therapy. Cognitive decline, alopecia, weight gain, and gastrointestinal distress are some of its common side effects. In addition, neural tube defects have been reported in one percent of babies born to females treated with valproate during pregnancy.

Second Generation Mood Stabilizers

Atypical antipsychotic drugs have been used extensively for the management of acute mania in the last several years. Emerging data suggests that drugs like risperidone, olanzapine, quetiapine, etc., are highly efficacious, with almost similar antimanic efficacy. These agents have demonstrated effectiveness as a substitute for lithium and are used in combination with mood stabilizers.

However, there is a shortage of data pertaining to their effectiveness in acute bipolar depression and maintenance treatment. Further, the available data needs to be simulated in future studies before establishing quetiapine as a gold standard of treatment for acute bipolar depression.

A 6-month duration study showed that aripiprazole could be effective in the prophylaxis of manic episodes, however, further studies with at least a duration of 12 months and having a large sample size are needed to establish this agent for the prevention of bipolar disorder.

And now, it is not known if ziprasidone, aripriprazole, and risperidone are effective in treating the symptoms of acute bipolar depression. Therefore, studies with longer duration and a larger sample size are warranted.

In general, the atypical antipsychotics are safe and effective medicinal agents for managing bipolar disorder.

  • Lamotrigine : An antiepileptic agent which has been recently declared as a standard treatment mechanism for the management of symptoms of bipolar disorder. It has been suggested that lamotrigine has the potential to alleviate an individual’s depressive symptoms without affecting their overall mood and without exacerbating the symptoms of mania. Nevertheless, it is a relatively new agent for the treatment of bipolar disorder, therefore, additional research is warranted to establish its effectiveness. In addition, researchers also need to establish if this agent can be taken in monotherapy or in combination therapy.

Effectiveness of Mood Stabilizers

Like any other medicine, mood stabilizers are the most effective when taken under the supervision of a registered mental health specialist and when one strives their best to remain compliant to the dosing schedule.

Further, the use of mood stabilizers should neither be stopped suddenly nor without medical supervision. Sudden cessation of these drugs, even when the mood appears to be stabilized, can lead to a relapse, introducing avoidable complications in the treatment plan.

Choose Invictus Health Group

Mood stabilizers, when used in conjunction with psychotherapy, alternative therapies, and support groups can prove to be effective in treating mental illnesses like bipolar disorder and MDD. All the behavioral health centers affiliated with Invictus Health Group offer evidence-based treatment programs for bipolar disorder with mood stabilizers. By offering a holistic combination of therapeutic modalities tailor-made to each individual, the evidence-based treatment plans at our network facilities aim at treating the disorder while reducing the risk of a relapse.

The treatment programs, offered in a compassionate, supportive and empowering environment, include medication management, traditional therapies like cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), individual, group and family-focused psychotherapies, and experiential therapies like music, meditation, yoga, and mindfulness.

For more information about bipolar disorder treatment centers and how our network of centers can help you overcome the disease and lead a better life, call our 24/7 helpline 866-548-0190 and speak to a member of our team. You can also chat online to a representative for further assistance.

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