Understanding Mood Stabilizers and Their Role
Mood stabilizers are a class of psychiatric medications used to treat intense and sustained mood shifts, most notably in individuals with bipolar disorder [1.8.1]. These medications help manage the highs of mania and the lows of depression, preventing relapses and allowing for a more stable emotional baseline [1.8.3]. They are a cornerstone of long-term treatment for conditions like bipolar I and II disorders, schizoaffective disorder, and sometimes impulse control disorders [1.8.4]. An estimated 4.4% of U.S. adults will experience bipolar disorder at some point in their lives, making effective treatment crucial [1.11.3]. While medication is a key component, the National Institute of Mental Health (NIMH) emphasizes that an effective treatment plan also includes psychotherapy [1.7.2].
So, What is the Most Prescribed Mood Stabilizer?
There isn't a single definitive answer to this question, as prescription patterns vary based on geography, patient diagnosis, and specific symptoms (mania vs. depression). However, data and clinical reports point to a few key players:
- Anticonvulsants: This class has become a dominant force in mood stabilization. Valproate (Depakote) is frequently prescribed, especially for treating manic episodes [1.4.1, 1.7.4]. Lamotrigine (Lamictal) is also extremely common and is particularly effective for preventing the depressive episodes of bipolar disorder [1.2.4, 1.7.4].
- Lithium: Often called the "gold standard" of mood stabilizers, lithium has been used the longest and is highly effective, especially for classic bipolar mania and in reducing suicide risk [1.2.3, 1.7.2]. However, its use has seen declines over the years due to its narrow therapeutic window, need for regular blood monitoring, and potential side effects [1.5.2, 1.9.4]. Despite this, it remains a first-line treatment [1.5.1].
- Atypical Antipsychotics: This newer class of drugs has seen a dramatic increase in use for bipolar disorder, in some cases supplanting traditional mood stabilizers [1.6.2]. Medications like Quetiapine (Seroquel), Aripiprazole (Abilify), and Olanzapine (Zyprexa) are widely prescribed alone or in combination with other mood stabilizers to manage mania and depression [1.2.1, 1.6.5].
In recent decades, trends show a significant rise in the prescription of atypical antipsychotics and a corresponding decrease in the use of traditional mood stabilizers like lithium, though lithium's use has shown modest increases in some recent analyses [1.6.2, 1.5.1].
The Main Classes of Mood Stabilizers
Mood-stabilizing medications are generally grouped into three categories [1.2.3].
Lithium
Lithium is a naturally occurring element that is highly effective for treating and preventing manic episodes [1.2.3]. Its exact mechanism isn't fully understood but is thought to involve effects on neurotransmitters and intracellular signaling pathways [1.8.1]. It is particularly effective in reducing suicide risk among people with bipolar disorder [1.7.2]. Treatment requires careful monitoring of blood levels to ensure efficacy while avoiding toxicity [1.9.1].
Anticonvulsants
Originally developed to treat seizures, these medications were found to be effective at stabilizing mood. They are believed to work by reducing abnormal excitability in the brain, possibly by affecting neurotransmitters like GABA [1.8.1, 1.8.3].
- Valproate (Depakote): Primarily used for managing manic episodes [1.7.4].
- Lamotrigine (Lamictal): Often used for maintenance treatment, with a strong antidepressant effect [1.7.4].
- Carbamazepine (Tegretol): Another option for treating mania and mixed states [1.7.4].
Atypical Antipsychotics
This modern class of medication treats symptoms of both mania and depression by acting on dopamine and serotonin receptors [1.2.3]. They can be used as monotherapy or as an adjunct to other mood stabilizers. Common examples include aripiprazole, olanzapine, and quetiapine [1.2.1]. The use of these medications for bipolar disorder has grown substantially over the last 20 years [1.6.2].
Comparison of Common Mood Stabilizers
| Medication | Primary Target | Common Side Effects | Monitoring Needs |
|---|---|---|---|
| Lithium | Mania, Maintenance | Increased thirst/urination, hand tremors, weight gain, metallic taste [1.9.4] | Regular blood tests for lithium levels, thyroid, and kidney function [1.9.1]. |
| Valproate | Mania, Mixed States | Drowsiness, dizziness, weight gain, nausea, potential liver problems, hair loss [1.9.4] | Liver function tests, blood cell counts [1.9.4]. |
| Lamotrigine | Depression, Maintenance | Dizziness, headache, blurred vision, nausea [1.9.4]. A rare but serious risk is Stevens-Johnson syndrome, a severe skin rash [1.9.2]. | Slow dose titration to monitor for skin rash [1.9.2]. |
| Quetiapine | Mania, Depression | Drowsiness, dizziness, weight gain, dry mouth, metabolic changes (increased blood sugar) [1.9.3, 1.9.4] | Monitoring of weight, blood pressure, and blood glucose/cholesterol levels. |
Conclusion: The Right Medication is a Personal Choice
While anticonvulsants like valproate and lamotrigine, alongside atypical antipsychotics, are among the most frequently prescribed mood stabilizers today, the 'best' medication is highly individual. The choice depends on the patient's primary symptoms (mania or depression), medical history, and tolerance for side effects [1.2.3]. Lithium remains a powerful and effective option despite its monitoring requirements. Effective management of bipolar disorder involves a collaborative approach between the patient and their healthcare provider to find the optimal treatment plan, which typically combines medication with psychotherapy [1.7.2, 1.10.2].
For more information, a great resource is the National Institute of Mental Health (NIMH).
