Mood Stabilisers

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Mood Stabilisers

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These are medications that help treat and prevent the highs and lows of Bipolar Disorder. They form the cornerstone of treatment for this illness. The exact mechanism of action which renders them effective in treating Bipolar Disorder is as yet unknown.

Lithium is the oldest and most well-known mood stabilizer. It is taken as a tablet, usually once nightly. It doesn’t work straight away – you must take it daily for one to two weeks before its mood stabilising effect takes hold. The effective dose for the person is determined by testing the blood lithium level a week after beginning lithium (or whenever dose changes are made) – this is done by a simple blood test performed in the morning, about 12 hours after the last lithium tablet has been taken.

As with all mood stabilisers, it is important to continue taking lithium even when the mood has stabilised – this is because it plays an important role in preventing further mood disturbances and also research has shown that if lithium is discontinued suddenly, it may trigger a ‘rebound’ episode of depression or mania. It is therefore very important to talk with your doctor before deciding to stop lithium.

The doctor will organise for routine blood tests and a heart tracing test (an ECG) before starting lithium to make sure that the person is fit to commence the medication, and it is also necessary to have regular blood tests once taking lithium (3-6 monthly).

Lithium may also be prescribed for those with unipolar depression to boost the effects of antidepressant medications, where these alone have not been effective in alleviating the symptoms of depression.

It is associated with an increased risk of certain foetal abnormalities if taken during pregnancy, so it is important if you are taking lithium and wish to become pregnant that you discuss your options with your doctor prior to trying to conceive. For some, it may be appropriate to continue lithium, but for others, a gradual phasing out of lithium and/or using an alternative medication may be indicated.

For more information on lithium see the below links:

This medication (which is also an anticonvulsant used in epilepsy) has been shown to be effective in treating mania and preventing relapse in bipolar disorder. It is usually prescribed for those in which lithium is ineffective or poorly tolerated. It may be especially useful for those who have relatively frequent episodes of mood disturbance. Regular blood tests are also required when on sodium valproate.

As with lithium, it is also associated with an increased risk of foetal abnormalities during pregnancy (the risk is greater for sodium valproate than lithium, and it is generally not recommended for use in women of childbearing age for this reason).

For insight into the national regulatory perspective on valproate-containing medicine, visit the Health Products Regulatory Authority website. It includes information on valproate, in particular use in women of child bearing potential, and for whom treatment is contraindicated unless the terms of a pregnancy prevention program are fulfilled.

For more information on sodium valproate, click on the links below:

  • Sodium Valproate – information about uses, side-effects, blood tests etc.
  • Medications for mania – Royal College of Psychiatry (UK) leaflet

Other anticonvulsant medications which are also used as mood stabilisers in Bipolar Disorder are:

  • Carbamazepine (also known as Tegretol) – this is used as a second line medication
  • Lamotrigine (Lamictal) – this is especially useful for bipolar depression.

Some antipsychotics can also be effective mood stabilisers, and these may be used alone or in combination with the above medications in bipolar disorder. Examples of such medication are olanzapine (zyprexa), quetiapine (seroquel), aripiprazole (abilify), risperidone (risperdal) or clozapine (clozaril).

For more information, click on the following links:

  • Information on medications useful in treating mood disorders (from – a reliable online resource for health information for the general public)
  • Antipsychotic medication (Information from the Royal College of Psychiatrists, UK)