This is the third post in a series in which I’m aiming to demystify some of the very basics of psychotropic medications. Make sure you read the first post to get some of the background before reading this post about mood stabilizers. And remember that I’m not a physician and in no way claim to be an expert on medications, so this educational information should not be interpreted in any way as clinical advice of any kind whatsoever. Talk to your prescriber about medications before making any changes — it can be very dangerous to change or stop your medications on your own.
Bipolar Disorder is a debilitating mental health condition characterized in most cases by extreme elevations in mood (not just happy but EXTREMELY elevated) alternating with depression. It’s not uncommon for there to also be lengthy periods of “normalcy” in between these episodes. Depression associated with Bipolar Disorder is treated differently than “regular” depression. This is in part because antidepressant medications can trigger mania in a person with Bipolar Disorder.
“Depression associated with Bipolar Disorder is treated differently than ‘regular’ depression. This is in part because antidepressant medications can trigger mania in a person with Bipolar Disorder.”
Lithium
Lithium is a commonly-prescribed mood stabilizer. It decreases symptoms of mania within a week or two and takes a little longer to decrease symptoms of depression (weeks to months). There are some pretty significant side effects, including
- Sedation
- Weakness
- Nausea
- Hand tremor
- Increased thirst and urination
- Cognitive slowing
- Weight gain
It’s also important to know that lithium is affected by caffeine use. Caffeine is a diuretic, meaning it makes you pee, and lithium is excreted in your urine. So if you’re consuming a lot of caffeine, you’re losing a lot of the lithium in your pee. That’s okay (sort of) as long as you are getting your blood monitored regularly and you don’t change your caffeine intake. But if you suddenly increase your caffeine consumption, then the medication may not be as helpful. And if you suddenly reduce how much caffeine you’re consuming, then you’ll have a lot more lithium staying in your body than usual, which can be dangerous.
Plus, lithium may cause diabetes insipidus (it’s not worth discussing, but this is different than diabetes mellitus…), which can cause dehydration, which can then increase levels of lithium in the body.
- Nausea, vomiting, diarrhea
- Drowsiness
- Mental dullness
- Slurred speech
- Blurred vision
- Confusion
- Dizziness
- Muscle weakness, muscle twitching, coarse tremor
- Incoordination, trouble walking
- Irregular heartbeat
- Seizures
- Coma
So it’s really important to make sure the dosage is in that window. For that reason, people taking lithium will have their blood drawn regularly.
Depakote
Divaloproex (Depakote) is another mood stabilizer. It was originally developed to manage seizures. Side effects include
- Weight gain
- Tremor
- Headaches
- Double vision
- Dizziness
- Anxiety
- Confusion
For reasons similar to lithium, people taking Depakote will have their blood drawn regularly because toxicity can be dangerous.
Anticonvulsants
Finally, some anticonvulsants (medications used to treat seizures) are helpful for someone who is in the active stages of mania (rather than as long-term maintenance of Bipolar Disorder) — carbamazepine (Tegretol) and lamotrigine (Lamictal).
Carbamazepine (Tegretol) can lower white blood cell counts and can change heart rhythms, so people taking this medication are usually closely monitored. It’s also tricky because initially your body will work really hard to remove it from your body, so the levels can go down and the dosage has to be increased to compensate for this. There are some side effects, too, including
- Sedation, drowsiness
- Dizziness
- Tremors
- Blurred vision
- Nausea, vomiting, diarrhea, abdominal pain
- Rash or hives
Other Medications
In addition to lithium and Depakote, other medications are also effective mood stabilizers, especially some of the atypical antipsychotics like
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Lurasidone (Latuda)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
And the FDA approves a combination of olanzapine (Zyprexa) and fluoxetine (Prozac), which is marketed as Symbyax, as a mood stabilizer. See my post about antipsychotics for more about their side effects.
Other posts in this series:
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Source: Patzer, D. Overview of Psychopharmacology. Magellan Health.
Source: Scheifler, P. Bipolar and Related Disorders. Magellan Health
Hayden C. Finch, PhD, is a practicing psychologist in Des Moines, Iowa, focused on helping you master your mental health.
