Mood Stabilizers
Prescription medicines used in bipolar disorder to reduce how far mood swings in either direction and to prevent the next episode.
- Type of medicine
- Taken by mouth, usually daily. Not controlled substances.
- Monitoring
- Lithium and valproate need periodic blood tests. Lamotrigine does not.
- Prescribed at Ridge Way
- In person in Sugar Hill and by telehealth across Georgia.
What Mood Stabilizers Are
Mood stabilizers reduce how far mood swings rather than flattening it. Their main purpose is to prevent the next episode, not only to treat the current one.
That is why they are taken during stable periods. The medicine is doing its job when nothing is happening, which is the hardest time to keep taking anything. Stopping during a good stretch is a common route back into an episode.
Conditions Treated
Bipolar disorder
Both poles. Some medicines suit mania better and others suit the depressive phase, which is why the choice depends on your pattern.
Preventing the next episode
Maintenance treatment continues after recovery. This is the main reason mood stabilizers are taken for years rather than months.
Schizoaffective disorder
Where mood episodes occur alongside psychotic symptoms, a mood stabilizer is often part of the plan.
Treatment-resistant depression
Lithium is sometimes added to an antidepressant that has not worked well enough on its own. See antidepressants.
Common Medication Types
Examples rather than a complete list. They are not interchangeable, and which one suits depends largely on which pole gives you more trouble.
Lithium
A first-line choice with the longest record. A meta-analysis of forty-eight trials found fewer suicides on lithium than on placebo in mood disorders.5 Needs periodic blood levels plus kidney and thyroid checks.2
Lamotrigine
Better for the depressive pole than the manic one. The dose is raised slowly over weeks because moving faster raises the risk of a serious rash.3
Valproate
Effective for acute mania. Needs blood level and liver monitoring, and is generally avoided in anyone who could become pregnant.4
Antipsychotics
Several are used as mood stabilizers, particularly for bipolar depression where the options are narrower. See antipsychotics.
Benefits and Expectations
Treatment is measured in years rather than weeks. The benefit is fewer and less severe episodes, which is easier to see looking back than day to day.
Combination treatment is common rather than a sign of failure. Needing a second medicine, or an antipsychotic alongside, is an ordinary part of managing bipolar disorder.
Common Side Effects
Which apply depends entirely on which medicine you are taking:
- Fine hand tremor, most often with lithium or valproate
- Increased thirst and urination, with lithium
- Nausea or stomach upset early on, often eased by taking it with food
- Drowsiness, more typical of valproate and lamotrigine
- Weight change, developing over months
- Hair thinning, with valproate
Thyroid and kidney changes on lithium are found by monitoring rather than by symptoms, which is what the periodic tests are for. Raise weight change and tremor early rather than after a year, because both can influence which medicine you stay on.
Important Safety Information
Any new rash on lamotrigine
Get medical attention the same day, particularly in the first two months. Nearly all serious rashes appear two to eight weeks after starting.3 Do not simply stop and wait to see: stopping does not by itself make a rash safe. Call us, and if you cannot reach us, go to urgent care or an emergency room.
Signs of too much lithium
Lithium has a narrow margin between an effective level and a toxic one, which is why the level is measured rather than estimated.2 Coarse hand tremor, vomiting or persistent diarrhea, unsteadiness, slurred speech or confusion all need same-day attention. Dehydration, a stomach bug, a hot week or a new medicine can push a stable level up without anything else changing.
Do not stop suddenly
Stopping a mood stabilizer abruptly is a common trigger for relapse, and stopping lithium suddenly is associated with a particularly sharp return of symptoms. If you want to reduce or stop, that is a legitimate conversation and it is planned rather than improvised.
Tell your prescriber about
- Pregnancy, planned pregnancy or breastfeeding, before starting where possible
- All other medicines and supplements, including anti-inflammatories and diuretics, which affect lithium levels
- How much alcohol you drink, and any period of vomiting, diarrhea or dehydration
- Any missed doses, particularly on lamotrigine, where a gap can mean the slow build has to start again
If you need help now. Contact your prescriber the same day if mood swings up sharply, if you need much less sleep than usual, or if thoughts of self-harm begin or worsen. Our office is open Monday to Friday, 9am to 6pm.
Ridge Way is not an emergency service. If someone is in immediate danger, call 911. For a mental health or suicide crisis, call or text 988, any time, or call the Georgia Crisis and Access Line at 1-800-715-4225. Crisis resources.
Frequently Asked Questions
How often will I need blood tests?
More often when starting or changing a dose, then at a routine interval once you are stable. Kidney and thyroid checks on lithium are typically once or twice a year.2 We send lab orders to a facility near you rather than asking you to come to the office.
Why is lamotrigine started so slowly?
Because raising it quickly increases the risk of a serious rash, and nearly all such rashes appear in the first two to eight weeks.3 The slow build substantially reduces that risk, which is why it is not shortened however frustrating the wait is.
Can I take these while pregnant?
It depends entirely on which one. Valproate carries significant risks and is generally avoided in anyone who could become pregnant.4 Lithium and lamotrigine need a considered discussion weighing the medicine against the risk of untreated bipolar disorder, which is not small. Do not stop on your own on finding out. See women’s mental health.
Will I be on this forever?
Often for a long time. Bipolar disorder is usually a recurring condition and mood stabilizers work by preventing the next episode, so the horizon is years rather than months. It is reviewed, and what you want out of treatment is part of that review.
Can I drink alcohol?
Alcohol destabilizes mood and sleep independently of anything you take, and it causes dehydration, which matters more on lithium than most people expect. Tell your prescriber how much you drink so advice can be specific to you.
References
- National Institute of Mental Health. Bipolar Disorder. Accessed September 2026.
- Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls, National Library of Medicine. Updated January 2024.
- Betchel NT, Fariba KA, Saadabadi A. Lamotrigine. StatPearls, National Library of Medicine.
- StatPearls, National Library of Medicine. Valproic Acid. Accessed September 2026.
- Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ 2013;346:f3646.
Careful Management for Mood Stabilizers
Lithium and lamotrigine need attention to detail: blood levels, slow titration, and knowing what to watch for. We’ll manage all of it with you. Book your appointment in person or online.