How to Choose a Mood Stabilizer

Choosing a mood stabilizer depends on many factors that you should discuss in depth with your psychiatrist or provider. Mood stabilizers are often prescribed for people diagnosed with bipolar disorder and aim to reduce symptoms and severity associated with mania and fluctuating moods.^{[1]XResearch source} Often, individuals need additional medications to treat depression, anxiety, or psychosis.^{[2]XTrustworthy SourceMindU.K.-based mental health charity focused on providing advice and resources to anyone facing mental health problems.Go to source} While medications can help ease symptoms, they often come with side-effects or may interact with other medications, so it's important to talk to your psychiatrist before choosing a medication.

Part 1

Part 1 of 3:

Considering Available Mood Stabilizers

1
Talk about taking lithium. Most people diagnosed with bipolar disorder will take lithium at one point or throughout their treatment. The benefits of lithium include evening out mood swings, treating depression and mania, and preventing mania.^{[3]XResearch source}^{[4]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source} Lithium appears to have strong anti-suicidal properties, which can be beneficial in treatment.^{[5]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source} Lithium takes about 10 – 14 days to take effect and about 50% of people notice improvements when taking lithium. Another 40 – 50% experience improvements when other medications are added to lithium.^{[6]XResearch source}
- Not taking lithium regularly or suddenly stopping use can increase your chances of feeling unwell or needing hospitalization.^{[7]XResearch source}
- Common side-effects include weight gain, thirst, dry mouth, and slight shakiness.^{[8]XResearch source}
- Lithium is available as a tablet, capsule, and liquid and should be taken two to four times per day.^{[9]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
- Be aware that lithium toxicity is a risk. Symptoms include nausea, vomiting, and diarrhea. Irregular heart beat, sluggishness, difficulty with coordination, confusion, and agitation.
- Do not take lithium if you are pregnant, as this puts the fetus at risk for heart defects.
2
Look into valproate. Also known as valproic acid or Depakote, valproate works best for those who are rapid cyclers and persons with a history of depression with mixed mania. People with bipolar who benefit from valproate include those with a history of head trauma, substance abuse, or have intellectual disabilities. Valproate can treat manic episodes that include psychosis and is used mostly to treat manic episodes.^{[10]XTrustworthy SourceMindU.K.-based mental health charity focused on providing advice and resources to anyone facing mental health problems.Go to source}^{[11]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source} Generally, it takes seven to 14 days for the medication to start having effects, and psychiatrists will not adjust the dosage prior to three weeks.^{[12]XResearch source}
- Common side-effects include weight gain, hair loss, or feeling sick. If you develop bruising or bleeding, notify your psychiatrist right away.^{[13]XResearch source}
- Valproate is available as a capsule, tablet, and liquid, delivered once to twice each day.^{[14]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
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3
Consider carbamazepine. Carbamazepine (also called Tegretol) is sometimes prescribed for people who do not respond favorably to lithium. It seems to work favorably for people who experience rapid cycling bipolar.^{[15]XResearch source} It primarily treats manic episodes and mixed episodes.^{[16]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source} Some people take carbamazepine together with lithium. This drug generally takes seven to 14 days to take effect, and if no effect is noticed within three weeks, your prescriber may try a different medication. Carbamazepine can interact with other drugs or have a lesser effect over time, which is why it is not prescribed as readily as other medications.^{[17]XResearch source}
- Carbamazepine tends to have fewer side-effects than lithium, but can include nausea, dizziness, sleepiness, and feeling ill.^{[18]XResearch source}
- This medication is available as a pill, chewable, capsule, or liquid, taken two to four times per day.^{[19]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
4
Think about lamotrigine. Lamotrigine (Lamictal) is prescribed primarily to treat severe depression and often given to treat bipolar II disorder.^{[20]XTrustworthy SourceMindU.K.-based mental health charity focused on providing advice and resources to anyone facing mental health problems.Go to source} Dosages must be increased slowly and cannot increase abruptly.^{[21]XResearch source} More research is needed in order to evaluate the effectiveness of treating bipolar disorder, however, it appears to effectively treat depression and manic episodes.^{[22]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source} It is primarily used to treat seizures and epilepsy.^{[23]XResearch source}
- Side-effects of lamotrigine include drowsiness, headache, diarrhea, insomnia, rash, and feeling ill.^{[24]XResearch source}
- Medication is available as a tablet, dissolvable tablet, and chewable, taken once or twice each day.^{[25]XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source}
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Part 2

Part 2 of 3:

Consulting with a Psychiatrist

1
Make an appointment with your prescriber. You cannot attain a mood stabilizer without a prescription. Most people choose to see a psychiatrist to manage mental health prescriptions, side-effects, and symptoms.^{[26]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} A psychiatrist is trained to monitor and treat mental health symptoms and has more experience treating mental health problems than a general practitioner.^{[27]XExpert SourcePadam Bhatia, MD
Board Certified PsychiatristExpert Interview. 3 April 2020.}
- Find a psychiatrist by calling your insurance provider or local mental health clinic. You can also obtain a referral from your general practitioner or ask for a recommendation from a friend.
2
Check back with your psychiatrist regularly. Early in treatment, speak with your psychiatrist regularly about your medication. Let your prescriber know about any side-effects or adverse effects you may be experiencing. Keep track of your moods, sleep, eating habits, and overall well-being, and relay any changes back to your provider. Keep regular appointments with your psychiatrist to monitor the effectiveness of your medication.^{[28]XExpert SourcePadam Bhatia, MD
Board Certified PsychiatristExpert Interview. 3 April 2020.}
- When you see your prescriber, let them know how you're doing on the medication and whether you need to adjust it or make changes.
3
Adjust medications if you are family planning. If you want to get pregnant, are pregnant, or are breastfeeding, it's important to discuss your treatment options with your prescriber. Some medications can be associated with birth defects and can be passed on to your baby through your breastmilk.^{[29]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- If you need to make changes to your medication, always speak with your prescriber.
4
Be open to other options. While mood stabilizers are generally used to treat bipolar, they are not the only option. Some prescribers may choose to treat your bipolar with antipsychotic medication, which includes risperidone, olanzapine or clozapine. They are used mostly to treat manic phases of bipolar disorder, but can also treat severe depression and other mental health diagnoses.^{[30]XTrustworthy SourceNational Institute of Mental HealthInformational website from U.S. government focused on the understanding and treatment of mental illness.Go to source} You may also take antidepressant medication.
- If your prescriber recommends an antipsychotic, it's not because you're “crazy.” It is one of many options if they do not believe that mood stabilizers are a good fit for you.
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Part 3

Part 3 of 3:

Monitoring Your Symptoms and Medications

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Track your moods and symptoms. One way to monitor your progress on medications is to keep track of your moods and symptoms daily. Consider keeping a bipolar symptoms and moods journal that you update regularly to include your sleep, emotions, and medication reactions.^{[31]XTrustworthy SourceUniversity of Rochester Medical CenterLeading academic medical center in the U.S. focused on clinical care and researchGo to source} Ask your friends and family to gently point out any fluctuating moods or changes in your behavior.
- Enlist the help of family and friends by asking, “I’m doing my best to manage my moods and symptoms and I started using medication. Will you please let me know if you notice any big changes in my behavior or moods?”
2
Exercise patience. Some medications take months to take full effect. If you're having adverse reactions, your prescriber will likely change one medication at a time. You may need to adjust your dosage or adjust your medications based on your side-effects and symptoms.^{[32]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} You may find that one medication works well but causes uncomfortable side-effects that may need another medication. Stay patient and always describe your symptoms to your prescriber.
- It can be frustrating managing side-effects and symptoms. Stay positive that you will find a good fit for your body.
- It may take months to get the right combination of medication for your treatment. Be compliant with your medication, and always take it as prescribed.
3
Get regular blood tests. Many mood stabilizers can affect your liver and kidney function, and it's important to monitor their health throughout treatment. This is typically performed through a simple blood test. At the beginning of treatment, you may need frequent blood tests (weekly or bi-weekly), which may become less frequent over time (once per year).^{[33]XResearch source}
- Ask your prescriber about any health risks associated with medication. You may wish to include your blood tests during your yearly physical examination.
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How do I know if I need a mood stabilizer?
Padam Bhatia, MD
Board Certified Psychiatrist
Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.
Padam Bhatia, MD
Board Certified Psychiatrist
Expert Answer
This isn't necessarily the kind of thing you'd be able to figure out on your own without some assistance, which isn't a slight against you, but more of a statement about the nature of treatment. Talk to your doctor and see a psychiatrist or some other kind of mental health professional and ask them this question. Your situation is going to be unique to you, so this kind of question requires a personal conversation with your treatment team.
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Major risk factor for antipsychotics include the development of fetal malformations while pregnant. The drugs from greatest to least risk factor include valproate, carbamazepine, lithium, and lamotrigine.
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