Mood-Stabilizing Drugs for the Treatment of Bipolar Disorder

The continuing advancements in medicine are extraordinary. For the pharmacological treatment of bipolar disorder, drugs are being prescribed that allow patients to stabilize their moods. But, what are mood stabilizers?

Written and verified by the psychologist Gorka Jiménez Pajares.

Last update: 07 February, 2023

Imagine a roller coaster, the quintessential attraction in the amusement park. When you’re sitting in one of their wagons and the ascent begins, you might feel overwhelmed with euphoria. However, when you reach the top, and the wagon descends, you may experience fear, anxiety, or dismay.

Imagine this happening with your mood, day after day, week after week. Something similar occurs in bipolar disorder, in which manic episodes (the high) and depressive episodes (the low) appear. Mood-stabilizing drugs have been used to reduce mood swings in these patients.

Bipolar disorder (BD) is a serious mental disorder with a high rate of associated suicide. Indeed, the suffering of people with BD is immense. Before talking about treatment with mood-stabilizing drugs, we’re going to define this clinical disorder.

Bipolar disorder

Bipolar is a chronic disorder, which means it has no cure. For it to be diagnosed, an individual has to have suffered a manic or hypomanic episode. The emotions of sufferers are characterized by phases of hyperactivity or hyperarousal (mania and hypomania). These alternate with periods of sadness and behavioral inhibition (depressive phases) and moments of clinical stability (euthymia). In addition, bipolar sufferers might present mixed episodes. These consist of simultaneously presenting depressive and manic symptoms.

Manic episodes that occur in bipolar are characterized by the presence, for at least a week, of an elevated and expansive mood. This can lead the patient to be irritable. There are also other symptoms. For example, excessive activity or the decreased need for sleep. It can profoundly interfere with the sufferer’s daily functioning.

For psychology professor Amparo Belloch, hypomanic episodes are similar to manic episodes. However, hypomania doesn’t interfere with the sufferer’s daily life.

Mood-stabilizing drugs

As a rule, people experiencing psychological problems occasionally suffer emotional turbulence. This is completely normal. But bipolar sufferers require a treatment that helps them prevent mania. In other words, to stabilize the manic pole.

In this article, we’re going to talk about two groups of stabilizing drugs that are frequently used: lithium and anticonvulsants.

1. Lithium salts

For some experts, lithium is the cornerstone of pharmacological treatment for bipolar. In fact, lithium is a classic mood stabilizer. It’s been used for more than 50 years in the treatment of bipolar disorder. It’s an ion whose mechanism of action is still unknown. That said, its effectiveness in manic episodes and in the prevention of relapses is both proven and documented.

Lithium is a mood stabilizer due to its antimanic effect. It’s the first-line treatment for all phases of bipolar, especially for those patients in whom manic episodes predominate.

Despite not fully knowing how lithium works, scientists believe that it may increase levels of serotonin and norepinephrine. This produces an antidepressant effect. At the same time, it regulates dopamine levels, producing an anti-manic effect.

Lithium requires close medical surveillance. That’s because its concentration in the blood must be between 0.6 and 1 mmol/l and it’s relatively easy for its levels to be altered by aspects of everyday life. For instance, the amount of salt in the diet.

On the downside, its adverse side effects are broad. They include gastrointestinal symptoms such as dyspepsia, nausea, vomiting, and diarrhea, as well as weight gain, hair loss, acne, tremors, or sedation.

2. Anticonvulsants as mood stabilizers

There are some drugs used in the treatment of epilepsy that may be useful in the treatment of bipolar disorder. Although their mechanism of action is also unknown, it’s believed that they could modulate the action of the GABA neurotransmitter, associated with calm and relaxation. Among the most used anticonvulsants are:

• Valproic acid. Along with lithium, it’s one of the most used mood stabilizers. However, its use in pregnant women should be avoided because it can cause malformations in the fetus. Indeed, it shouldn’t be given to any women of childbearing age. As with lithium, treatment with this drug must be closely monitored because its levels in the blood must remain between 50 and 100 mg/L. The effectiveness of valproic acid on the manic phase of bipolar has been proven. It’s also effective in the treatment of migraine.
• Carbamazepine. This was the first anticonvulsant to demonstrate its effectiveness in the manic phase of bipolar. Its side effects include skin rashes and changes in sodium levels (hyponatremia). Proper medical supervision is required because blood levels must remain between five and 12 µg/ml. Its effects on the fetus are known, and it should be avoided in pregnant women and women of childbearing age. This drug is also useful in the treatment of neuropathic pain.
• Oxcarbazepine. This is similar to carbamazepine. It has the advantage that it’s not necessary to control its concentration levels in the blood. Moreover, it has fewer side effects.
• Lamotrigine. There’s a robust solidity of scientific evidence behind the use of this drug in preventing both depressive and manic episodes in bipolar. It’s also one of the few psychoactive drugs that act on bipolar depression. In addition, it’s generally well tolerated by patients.

Further research

At present, there are numerous tools available that allow intervention in bipolar disorder and the prevention of its recurrence.

Recurrence refers to repeated relapses after a phase of full recovery. Despite the above, more research is necessary. Furthermore, health policies should be implemented that combat the stigma associated with bipolar to allow sufferers to fully integrate into society as essential and important members.