What Are the Best Mood Stabilizers for Bipolar Disorder?

If you have bipolar disorder, you know that managing ups and downs in mood can be challenging. Mood stabilizers for bipolar disorder can help manage both the highs (mania) and lows (depression). These medications work by restoring the balance of neurochemicals in the brain and by decreasing brain activity. They should make you feel leveled out and stable. This will help reduce symptoms like euphoria, risky behavior (like overspending), and agitation.  

Related: Bipolar Medications: Understanding your options.

Mood Stabilizers for Bipolar

Here are some of the most common mood stabilizing drugs used in bipolar disorder.  

Lithium (Priadel, Lithobid, or Eskalith) 

Lithium is an element that occurs naturally. An interesting fact is that it is third on the periodic table! Lithium has been used for bipolar disorder for more than 50 years. Besides electroconvulsive therapy (ECT), lithium is the single most effective treatment in psychiatry, according to researchers. 

Lithium is the only mood stabilizer that has been found to significantly reduce the risk of suicide and overall mortality for those with bipolar disorder. It also reduces the risk of heart disease, cancer, viral illness, and stroke. 

The disadvantage to lithium for bipolar is that it can cause thyroid and kidney damage over time. Additionally, this medication can be toxic if too much of it builds up in your blood. Lithium requires frequent blood monitoring because of these risks. 

The use of lithium for bipolar has been declining (in the United States) over the past few years, likely because of concerns about toxicity, kidney damage, and the burden of frequent monitoring.  Regardless, it’s considered the “Gold Standard” treatment for bipolar disorder. 

Sodium Valproate (Depakote)

Sodium valproate is an anticonvulsant medication that is used to treat acute bipolar mania and mixed episodes. This medication is not very effective for bipolar depression. Depakote is not recommended if you are pregnant. It has been placed in the pregnancy category X by the FDA, as it can cause serious harm to the fetus. 

Lamotrigine (Lamictal)

Lamotrigine is an anti-epileptic medication that is also approved by the Food and Drug Administration (FDA) as a maintenance treatment for bipolar depression. It was the first FDA-approved medication for bipolar disorder maintenance since lithium.  Lamotrigine has been found in clinical studies to help delay episodes of mania, hypomania (a milder form of mania), mixed episodes, and depression. Lamotrigine is not effective for acute mania. 

Carbamazepine (Tegretol) 

Carbamazepine is an anticonvulsant medication that is FDA-approved to treat acute manic or mixed manic episodes in bipolar 1 disorder. It’s been used for more than 30 years for bipolar disorder. It’s been found to be a safe and well-tolerated therapy in clinical trials. 

Oxcarbazepine (Trileptal) 

Oxcarbazepine is an anticonvulsant medication that is sometimes used off-label for bipolar disorder. However, it is not FDA-approved for this condition. Studies have found that it has promise in preventing manic episodes. 

Do Mood Stabilizers Have Side Effects? 

Side effects are common with mood stabilizers — like all medications, especially the first couple of weeks. With continued usage, they should go away or decrease in severity.  The exact side effects caused by mood stabilizers depend on the medication. If you’re experiencing severe side effects, contact your doctor right away.  

Also, be aware that some mood stabilizers may interact with other medications. For example, lithium cannot be taken with Ibuprofen because of the risk of lithium toxicity. Always check the medication label or talk to your pharmacist to learn the side effects and potential drug interactions.  

Related: Can you manage bipolar without medications? 

FAQs 

Here are the most frequently asked questions that people have about bipolar mood stabilizers.

What are the best mood stabilizers for bipolar depression? 

Lamotrigine (Lamictal) is one of the best mood stabilizers for the prevention of bipolar depression. Lurasidone (Latuda) is an antipsychotic that has been found to be particularly effective for bipolar depression. 

What are the best mood stabilizers for bipolar mania?

Lithium is one of the best mood stabilizers for mania. Sodium valproate is also used for mania. Mood stabilizers, including lithium, can sometimes take a couple of weeks to reach their full effect, so other medications like antipsychotics may also be used to treat acute mania. 

Is there a specific medication for bipolar anger?

Anger or rage can be a sign of a bipolar mood episode. Mood stabilizers like lithium, lamotrigine, and sodium valproate may help with bipolar anger and irritability.

Are antidepressants mood stabilizers?

Antidepressants are used to treat depression. However, they are not (or very carefully) used as mood stabilizers for bipolar disorder because of the risk of triggering a manic or mixed episode.