What Is the Most Commonly Prescribed Mood Stabilizer? An Overview

October 9, 2025 •

5 min read

While lithium is historically considered the “gold standard” mood stabilizer, recent studies and evolving clinical practices show that other medications, including valproic acid and lamotrigine, are also extremely common in a dynamic field where the answer to “What is the most commonly prescribed mood stabilizer?” depends on context. Prescribing trends have shifted, moving away from a singular focus on lithium to a broader consideration of several highly effective options.

Quick Summary

The most common mood stabilizer prescribed is not a single drug, but depends on clinical context, including patient factors and specific symptoms. While lithium was historically dominant, medications like valproic acid and lamotrigine are now frequently used, reflecting shifts in prescribing patterns over time. The choice among these and other options is highly individualized based on patient needs.

Key Points

Lithium is the historic standard: While once the most dominant mood stabilizer, lithium is now one of several leading options, primarily known for treating classic mania and preventing suicide.
Valproic acid is a leading alternative: The anticonvulsant valproic acid (divalproex) is widely prescribed, often for patients with rapid-cycling bipolar disorder and mixed states.
Lamotrigine targets bipolar depression: This medication is particularly effective for preventing depressive episodes in bipolar disorder, although less so for acute mania.
Prescribing patterns are shifting: Data shows a decline in exclusive reliance on older mood stabilizers, with increasing use of anticonvulsants and atypical antipsychotics to meet diverse patient needs.
Choice is highly individualized: The selection of a mood stabilizer depends on the patient's specific symptoms, comorbidities, and demographic factors, rather than a single medication being universally most common.
Atypical antipsychotics are also common: Medications like quetiapine are frequently used as mood stabilizers, particularly for acute mania, and in some contexts may be prescribed more than traditional options.

The Evolving Landscape of Mood Stabilizer Prescriptions

The question of which mood stabilizer is most commonly prescribed does not have a simple, static answer. For decades, the element lithium was considered the gold standard for treating bipolar disorder, largely due to its proven efficacy, particularly in preventing manic episodes. However, the landscape of psychotropic medication has evolved significantly. New drug options, along with a deeper understanding of varying patient needs, have diversified prescribing habits. For instance, a 2020 study from the Brain and Behavior Research Foundation found a significant shift in the treatment of bipolar disorder outpatients, with the prescription rate for traditional mood stabilizers declining in favor of second-generation antipsychotics over a 20-year period. This reflects a more nuanced approach, where medication choice is tailored to the individual patient’s specific symptoms and needs.

Leading Contenders for Most Common Mood Stabilizer

While prescription patterns can vary by region, time period, and specific patient population, several medications consistently rank among the most frequently prescribed mood stabilizers. The most prominent of these are lithium, valproic acid (divalproex), and lamotrigine.

Lithium (Lithobid, Eskalith)

As the oldest and most extensively studied mood stabilizer, lithium remains a cornerstone of bipolar disorder treatment. It is particularly effective for treating classic euphoric mania and has been shown to reduce the risk of suicide. However, managing lithium therapy requires regular blood monitoring due to its narrow therapeutic window—a patient's dose must be carefully balanced to be effective without becoming toxic. This need for strict monitoring can sometimes deter prescribers and patients, contributing to a decline in its overall usage compared to newer drugs.

Valproic Acid (Depakote)

Valproic acid, commonly known by its brand name divalproex, is an anticonvulsant medication that has become a highly popular alternative to lithium, especially for certain types of bipolar disorder. It is often preferred for patients with rapid-cycling bipolar disorder and mixed states, as it can act more quickly and has a wider therapeutic window than lithium, reducing the need for intensive blood monitoring. However, it comes with its own set of precautions and risks. Most significantly, valproic acid is harmful to a fetus and is generally contraindicated for women of reproductive age. It also carries risks of potential damage to the liver and pancreas, and may decrease blood platelet counts, requiring careful oversight.

Lamotrigine (Lamictal)

Another anticonvulsant used as a mood stabilizer, lamotrigine is primarily valued for its effectiveness in managing the depressive episodes of bipolar disorder. Unlike lithium and valproic acid, it is less effective for acute mania but is highly valuable as a maintenance therapy to prevent depressive relapses. A notable safety consideration with lamotrigine is the risk of a severe skin rash known as Stevens-Johnson syndrome, particularly if the dosage is increased too rapidly. This necessitates a very gradual dose titration when beginning treatment.

Comparison of Common Mood Stabilizers

To better understand the differences between the leading mood stabilizers, the following table compares their primary uses and characteristics.


Feature	Lithium	Valproic Acid (Divalproex)	Lamotrigine
Primary Indication	Acute mania, long-term prophylaxis for manic and depressive episodes, suicide prevention.	Acute mania (especially rapid-cycling), mixed states, migraine prevention.	Maintenance treatment for bipolar depression, preventing depressive relapses.
Speed of Action	Slower onset, often requiring 1–2 weeks for effect.	Faster onset, generally used for acute manic episodes.	Requires slow dose titration over several weeks to minimize rash risk.
Therapeutic Window	Narrow therapeutic window, requiring regular blood level monitoring.	Wider therapeutic window, less frequent monitoring needed than for lithium.	No blood level monitoring required for efficacy, although side effects are monitored clinically.
Key Risks	Kidney and thyroid issues, narrow therapeutic range, toxicity risk.	Harmful to fetus (contraindicated in pregnancy), liver and pancreatic risks.	Risk of serious skin rash (Stevens-Johnson syndrome), especially during rapid titration.

Factors Influencing Prescription Choices

The selection of a mood stabilizer is a complex process that depends on a patient’s specific clinical profile. A physician will weigh multiple factors, including:

Symptom Profile: Is the patient presenting with mania, depression, or mixed episodes? For a patient with prominent depressive symptoms, lamotrigine might be the primary choice, whereas lithium or valproic acid might be considered for a manic patient.
Patient Demographics and Comorbidities: A patient's age and sex are critical. For example, valproic acid is generally avoided in women of childbearing potential due to teratogenicity. Co-occurring conditions like anxiety or substance use disorders also influence the choice, with some evidence suggesting better outcomes with certain medications for specific comorbidities.
Side Effect Tolerance: A patient's individual tolerance for side effects, such as sedation, weight gain, or gastrointestinal upset, plays a significant role in determining long-term adherence.
Treatment History: A patient’s previous response to medication is a strong predictor of future success. If a patient has responded well to a particular medication in the past, that drug is often the preferred choice for future treatment.

The Role of Atypical Antipsychotics

In addition to the traditional mood stabilizers, second-generation (atypical) antipsychotics are also frequently used to manage mood symptoms, particularly in acute mania or as adjunctive therapy. In fact, some studies, such as the Finnish nationwide cohort study, show that an antipsychotic like quetiapine can be prescribed more often than traditional mood stabilizers. While not always considered a mood stabilizer in the strictest sense, their ability to stabilize mood means they are often included in the same treatment discussion.

Conclusion

There is no single answer to the question, 'What is the most commonly prescribed mood stabilizer?'. While lithium retains its historic significance and specific efficacy, particularly for manic episodes and suicide prevention, prescribing practices have diversified. Valproic acid and lamotrigine are highly prevalent, each with distinct advantages for different phases of bipolar disorder. The increasing role of atypical antipsychotics further adds to the complexity. Ultimately, the “most common” mood stabilizer is the one that is best suited for an individual patient’s unique clinical needs, as determined through careful consideration by their healthcare provider. It is not about a single drug's dominance but about a personalized approach to effective mental health management.

National Center for Biotechnology Information (NCBI) on Lithium: https://www.ncbi.nlm.nih.gov/books/NBK519062/

Frequently Asked Questions

Antidepressants primarily work to increase certain neurotransmitters in the brain to treat depression. In contrast, mood stabilizers work more broadly to level out severe mood swings, effectively treating both manic and depressive episodes associated with conditions like bipolar disorder.

Lithium use has declined primarily due to the introduction of other effective mood stabilizers like valproic acid and lamotrigine, which often have wider therapeutic windows and different side effect profiles. The need for strict blood monitoring with lithium is also a factor.

No, valproic acid is generally contraindicated for pregnant women due to its significant risk of causing birth defects. Alternative medications are typically used for women of childbearing potential.

The most significant risk is the development of a severe, life-threatening skin rash known as Stevens-Johnson syndrome. This risk is highest when the dose is increased too quickly, which is why a gradual titration is necessary.

While mood stabilizers primarily target extreme mood swings, some, like valproic acid and lamotrigine, can have an anxiolytic (anxiety-reducing) effect. However, they are not typically considered a first-line treatment for anxiety disorders alone.

Most mood stabilizers take time to become fully effective. It can take several weeks (e.g., 4–6 weeks) to notice significant effects, and some, like lamotrigine, require a slow dose increase over several weeks to reach a therapeutic level.

Second-generation (atypical) antipsychotics are used as mood stabilizers because they can effectively treat acute mania and help stabilize mood, often through different mechanisms than traditional mood stabilizers. They are frequently used in combination with other medications.