There is more than one class of psychotropic medications that have mood-stabilizing properties, such as atypical antipsychotics and antiepileptic medications.
Mood stabilizers are a group of medications used for several reasons. Most notably, they modulate a range of moods, both high (mania) and low (depression).
The term “mood stabilizer” generally refers to medications that also have antiseizure properties and are traditionally used to treat conditions with elements of emotional dysregulation, such as:
- bipolar disorder
- impulse control disorders
- personality disorders, such as borderline personality disorder or histrionic personality disorder
Common mood stabilizers include:
- sodium valproate (Depakote)
- lamotrigine (Lamictal)
- topiramate (Topamax)
- gabapentin (Neurontin)
These medications can also be used for other purposes, like to prevent seizures, control impulses (in impulse control disorders such as intermittent explosive disorder), or to help with tapering off a substance.
It’s not certain exactly how these medications work for mania or bipolar depression.
It’s likely that the stabilization of membrane concentration gradients within the central nervous system stops charged particles from flowing down these gradients and inhibits neural impulse.
This theoretical principle explains the ability of these medications to modulate mood, but would also explain other clinical uses, such as seizure control or tapering from substances.
In bipolar disorder, mood stabilizers may help with depressive symptoms. They are sometimes combined with antidepressants, as long as the person is on a mood stabilizer to prevent episodes of mania or mixed episodes.
Theoretically, any substance that stabilizes the membrane and keeps charged particles from moving down concentration gradients would have potential mood-stabilizing properties.
Valerian root could function as a low potency alternative for more traditional medications like Depakote or GABA (a neuropeptide in your central nervous system that has depressant effects).
GABA-enhancing products might serve as an alternative to gabapentin (a prescription mood stabilizer). Omega-3 fatty acids, as well as N-acetyl cysteine (NAC), are other substances that have purported mood-stabilizing properties.
It’s best to consult with your doctor before trying any new supplements in place of medication.
This physiological mechanism of stabilizing membrane systems, promoting conduction delay, would allow you to predict possible therapeutic benefits as well as side effects.
This would apply to most organ systems and could include side effects such as constipation, sedation, or conduction delay.
Each mood stabilizer may have additional side effects unique to the medication, as opposed to the common general class of medications. Examples of this might include:
- Depakote: potential liver damage
- Lithium: potential effects on the kidneys and thyroid
- Lamictal: potential for Stevens-Johnson syndrome
- Topiramate: potential for word-finding issues, kidney stones, or altered taste for carbonated beverages
Keep in mind, these aren’t all of the side effects that can occur with these drugs. Talk with your doctor to learn about other side effects that may occur.
Some remedies like St. John’s wort can be found in health food stores or apothecaries. These are readily available over the counter and include such substances as omega-3 fatty acids, NAC, and valerian root.
These can be fine additional measures, but you should discuss with your doctor if you’re thinking about adding supplements to your treatment regimen.
It may not be appropriate to rely on over-the-counter alternatives in place of traditional medication. Supplementary alternatives may hinder medication effects or increase side effects.
Generally, mood stabilizers are also used for seizure disorder or migraine. This includes:
Atypical antipsychotics, such as Latuda or Zyprexa, can also be used to help stabilize mood. Doctors typically prescribe Lamictal as a mood stabilizer but they may also prescribe it “off-label” for bipolar depression.
The term antidepressant is traditionally used to denote selective serotonin reuptake inhibitors (SSRIs). These include:
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- escitalopram (Lexapro)
- citalopram (Celexa)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) include venlafaxine (Effexor) and desvenlafaxine (Pristiq). Other antidepressants include bupropion (Wellbutrin) and mirtazapine (Remeron).
All the formal antidepressants tend to help increase levels of serotonin, norepinephrine, or dopamine.
Medications such as Depakote and lithium may be more invasive in that they require consistent blood monitoring and potentially serious side effects.
The medications that tend to be less problematic in regard to management and side effects include Neurontin and Topamax. Proper monitoring and bloodwork are required to ensure safety, though not that often.
Each medication should be considered in the context of your condition and how it may interact with your existing regimen.
A psychiatrist or other mental health professional who can prescribe medication is the best resource to optimize clinical results and ensure proper use and maintenance for success.
Dr. Jeff Ditzell is a practicing psychiatrist located in the heart of the financial district in New York City. He has a clinical focus on adult ADHD, depression, and anxiety.