This section covers:
•How do mood stabilisers work?
•Lithium
•Valproate
•Carbamazepine
•Lamotrigine
•Antipsychotics

How do mood stabilisers work?

It is not yet known exactly how mood stabilisers work. They appear to have the effect of stabilising swings between mania (feeling high) and depression.

What different types of mood stabilisers are there?

There are a number of mood stabilisers used both to reduce mania and depression, and in the long-term stabilise mood swings. Mood stabilisers are usually considered during an episode of mania or depression that appears, changes or worsens suddenly (you may hear this referred to as an acute episode). Long-term treatment is considered after two or more acute episodes.

Drugs used as mood stabilisers include:

Lithium

Lithium is widely used for the long-term maintenance and treatment of mania. It reduces both the number and severity of relapses. It is recommended by NICE guidance as a medication to treat episodes of mania and also as long-term treatment in bipolar disorder. If you have an episode of mania that comes on suddenly or becomes worse, lithium would usually only be started if your symptoms were not severe as it can take at least a week to take effect, which is slower than the other options available. Lithium has been found to reduce the risk of suicide.

In order for the lithium therapy to work, you must have a certain level in your blood stream. To make sure that the lithium is working properly and is not at a dangerous level, it is recommended you have regular blood tests to check the lithium levels in your blood every 3 months.

Lithium is sodium based, so changes to salt levels in the body can cause an imbalance. This can lead to increased levels of lithium. These levels can increase to a point where they are toxic to the body and cause poisoning. This risk can be increased by going on low salt diets, becoming dehydrated and interactions with certain medications. If you would like more advice about this, then please talk to your doctor.

Valproate

Valproate is an anti-convulsant medication used in epilepsy. In the UK, it is widely used in the form of sodium valproate, although it can come in other forms. It is licensed to treat mania.

NICE guidance for bipolar disorder recommends valproate as a first choice to treat episodes of mania and also for long-term treatment. However, it is not recommended to be prescribed to women of child bearing age (please see the section on Pregnancy).

You will also need regular tests, as valproate can affect how your liver works. NICE guidance recommends testing the functioning of your liver at the start of treatment and every 6 months after that.

Carbamazepine

Carbamazepine is an anticonvulsant medication used in epilepsy. In the UK, it is licensed to treat bipolar disorder in people who do not respond to lithium. NICE guidance does not recommend it as a first option to treat episodes of mania or as a long-term treatment. In order to be effective, carbamazepine has to reach a given level in the blood.

Lamotrigine

Lamotrigine is also an anti-convulsant medication used in epilepsy. In bipolar disorder, it may be used where depression is the main problem. NICE guidance does not recommend it to treat episodes of mania, or as a first option for long-term treatment of bipolar disorder.

Antipsychotics

As well as their antipsychotic effect, antipsychotic medication can also have mood stabilising properties. Some of the newer antipsychotics (sometimes referred to as atypical) can be used in bipolar disorder. In the UK, olanzapine, risperidone, quetiapine, aripiprazole and asenapine are licensed to treat mania. Olanzapine is probably the most widely used for this purpose.