Mood stabilisers

This section gives information about medication that can stabilise the highs and lows of your mood. These are often known as mood stabilisers.

Overview

  • You may get mood swings if you have some mental illnesses, including bipolar disorder (previously called manic depression), schizoaffective disorder and personality disorder.
  • Mood swings can mean that you have high moods (mania) and low moods (depression). If you have a mood disorder, you may be given mood stabilising medication which evens out the highs and the lows of your mood.
  • There are different types of medication that can help stabilise mood.
  • Everyone reacts differently to medication and there can be side effects. Speak to your doctor about your medication if you have any questions.

About

What are mood stabilisers?

Mood stabilisers are a type of medication that can help if you have unhelpful moods swings such as mania, hypomania and depression They help to control and ‘even out’ these mood swings.

Mania

Symptoms of mania can include:

  • feeling happy or excited, even if things are not going well for you,
  • being full of new and exciting ideas,
  • moving quickly from one idea to another,
  • hearing voices that other people can’t hear,
  • being more irritable than normal,
  • feeling more important than usual,
  • talking very quickly, jumping from one idea to another, racing thoughts,
  • being easily distracted and struggle to focus on one topic,
  • being over familiar with people,
  • not being able to sleep, or feel that you don’t want to sleep,
  • thinking you can do much more than you actually can,
  • making unusual, or big decisions without thinking them through, and
  • doing things you normally wouldn’t which can cause problems. Such as:
    • spending a lot of money,
    • being more interested in sex,
    • using drugs or alcohol,
    • gambling or
    • making unwise business decisions.

Hypomania

Hypomania is like mania but you will have milder symptoms. Treatment for hypomania is similar to the treatment for mania.

Depression

Symptoms of depression can include:

  • low mood,
  • having less energy and feeling tired,
  • feeling hopeless or negative,
  • feeling guilty, worthless or helpless,
  • being less interested in things you normally like doing or enjoying them less,
  • difficulty concentrating, remembering or making decisions,
  • feeling restless or irritable,
  • sleeping too much or not being able to sleep,
  • feeling more or less hungry than usual,
  • losing or gaining weight, when you do not mean to, and
  • thoughts of death or suicide, or suicide attempts.

Your mood may change quickly between mania and depression.

Your doctor may prescribe mood stabilisers if you have an episode of mania, hypomania or depression that changes or gets worse suddenly. This is called an acute episode. Some people need to take mood stabilisers as a long-term treatment to stop this from happening. You may experience mania or depression if you have a condition such as bipolar disorder, schizoaffective disorder, depression or personality disorder.

You can find more information about:

  • Bipolar disorder by clicking here.
  • Schizoaffective disorder by clicking here.
  • Depression by clicking here.
  • Personality disorder by clicking here.

Types & Choice

Are there different types of mood stabilisers?

There are different types of medication that can help stabilise your mood. The National Institute of Health and Care Excellence (NICE) produce guidelines for the assessment and treatment of mental illnesses, such as bipolar disorder and schizoaffective disorder. Your doctor should use these guidelines to decide which medication to offer you. You can find these in the further reading section below.

The most common mood stabilisers are listed below.

Lithium

Lithium is used for the long-term treatment of mania. It can reduce how often you get an episode and how severe they are. It has been found to reduce the risk of suicide.

NICE guidance for bipolar disorder recommends lithium as a first choice to treat episodes of mania and also for long-term treatment.

To make sure that the lithium is working properly and is not at a dangerous level, you should have tests to check the lithium levels in your blood every 3 to 6 months. Your doctor may give you a booklet to keep a record of your lithium levels.

Lithium comes in 2 forms. A tablet and a liquid.

The tablets are made from lithium carbonate. There are different brand names for the tablets. Some of these are:

  • Camcolit,
  • Priadel, and
  • Liskonum.

The liquid is made from lithium citrate. The main brand names for the liquid are:

  • Priadel liquid, and
  • Li-liquid.

Valproate

NICE guidance for bipolar disorder recommends valproate to treat episodes of mania and also for long-term treatment. Especially if lithium has not worked or is unsuitable.

Valproate is a medication used to treat epilepsy. But it is also used to treat mania. There are different forms of valproate. Valproic acid comes in the form of tablets and capsules. The main brand names for valproic acid are:

  • Belvo
  • Depakote, and
  • Convulex.

Sodium valproate can be given by injection, tablets and granules. The main brand name for sodium valproate are:

  • Episenta, and
  • Epilim.

Lamotrigine

This is sometimes called Lamictal. It is a medication used to treat epilepsy. It can come in the form of a tablet or a dispersible tablet. Which means that you dissolve it in water before taking it.

It can treat bipolar disorder when depression is the main problem. NICE guidance does not recommend it to treat episodes of mania, or as a first option for long-term treatment of bipolar disorder.

Antipsychotics

Antipsychotic medication can help to stabilise mood. This type of medication is normally used to treat symptoms of psychosis. Symptoms of psychosisinclude delusions, hallucinations and paranoia. Some of the newer antipsychotics can be used to treat bipolar disorder. NICE guidelines recommend the following antipsychotics if you have bipolar disorder.

  • Olanzapine.
  • Haloperidol.
  • Quetiapine.
  • Respiridone.

Can I choose my medication?

The best treatment for you will depend on your symptoms or diagnosis. This should be based on what you, your doctor or your healthcare team agree to.

If you do not feel you are being listened to then you could try and get help from an advocate. An advocate can help you to make your voice heard. They can talk to professionals to make sure you get the right help and treatment.

You can find more information about:

• Psychosis by clicking here.
• Antipsychotics by clicking here.
• Advocacy by clicking here.
• Medication – Choice and managing problems by clicking here.

Side effects

Are there any side effects?

If you take mood stabilisers you may find that you get side effects. Some side effects may only last for a short time or become easier to cope with. If you are worried about the side effects of your medication, speak to your doctor. Sometimes a lower dose or changing your medication will reduce side effects.

Side effects of lithium

Most side effects are directly related to how much lithium is in the blood stream. These are some side effects of lithium:

  • stomach pain,
  • feeling sick,
  • shaking,
  • a metallic taste in your mouth,
  • feeling thirstier and needing to pass urine more frequently, and
  • weight gain.

You should get regular blood tests to make sure you have a safe level of lithium in your blood.

Taking lithium can change the amount of sodium in your body. This can lead to higher levels of lithium which can cause poisoning. This can be made worse by diarrhoea or vomiting, not drinking enough water or other medications. If you would like more advice about this, speak to your doctor.

Side effects of valproate

Valproate can cause:

  • stomach upset and feeling sick,
  • hair loss,
  • memory loss,
  • problems concentrating,
  • headaches,
  • dizziness,
  • confusion,
  • deafness,
  • feeling sleepy,
  • hallucinations, and
  • tremors.

In women, valproate can cause increased testosterone levels. This can lead to periods stopping and abnormal hair growth.

Valproate may be linked to a condition called polycystic ovaries in women. This can affect how the ovaries work, which can cause symptoms including excessive body hair, irregular periods, problems getting pregnant or acne.

If you are pregnant, valproate can cause problems with the unborn baby. If you are able to have children, your doctor must not prescribe you valproate unless you are on the pregnancy prevention programme. See below for more information.

Valproate can affect how your liver works, so you will need regular tests. NICE guidance says to test your liver at the start of treatment and every 6 months after that.

Side effects of lamotrigine

Common side effects include:

  • aggression,
  • joint pain,
  • becoming agitated,
  • vomiting and diarrhoea,
  • drowsiness,
  • dizziness,
  • dry mouth,
  • tiredness,
  • irritability,
  • headaches,
  • tremors, and
  • sleep problems.

Side effects of antipsychotics

The side effects of antipsychotics can be different depending on which type of antipsychotic you take.

You can find more information about ‘Antipsychotics’ by clicking here.

Stopping & other considerations

What if I want to stop taking mood stabilisers?

Do not stop taking your mood stabiliser without first talking to your doctor. If you need to stop, your doctor can reduce the dose slowly over a few weeks. You should look out for signs of your illness returning if you are stopping your medication.

You may get withdrawal symptoms if you stop taking your medication suddenly. These symptoms depend on the medication you are taking. Talk to your doctor about withdrawal symptoms before stopping your medication.

Do mood stabilisers affect other medication?

You should tell your doctor if you are taking any other medication before starting or stopping mood stabilisers. This includes herbal or complementary medication, such as St Johns Wort.

There are also some common over-the-counter medications which can cause effects, some severe, when taken with mood stabilisers. These include:

  • codeine,
  • paracetamol, and
  • Ibuprofen.

Your doctor can give you advice on whether your mood stabiliser will affect any other medication.

Does alcohol affect my mood stabiliser?

Alcohol is not recommended when using some mood stabilisers.

Drinking alcohol whilst taking valproate can increase your risk of liver damage. And drinking alcohol whilst taking lamotrigine can affect your ability to perform skilled tasks, such as driving.

Your doctor should talk to you about how alcohol may affect your medication.

Can I drive when taking mood stabilisers?

Some mood stabilisers may make you drowsy and affect your driving. Tell the DVLA if you are taking medication that may affect your driving. You should also tell them if you have a medical condition that could affect your driving.

You can find out more about ‘Driving and mental illness’ by clicking here.

What else should I consider before taking mood stabilisers?

Sex

Medication can affect sexual desire (libido), arousal and your ability to have an orgasm. If this happens, talk to your doctor. Changing the dose could help with this problem.

Pregnancy

If you are thinking of trying for a baby, speak to your doctor about your medication.

Your doctor should give you information about the effects that medications can have during pregnancy.

If you are pregnant and need to take a mood stabiliser speak to your doctor. Some mood stabilisers can cause problems if you take them whilst you are pregnant. It is important that any decision about treatment during pregnancy weighs up the individual risks and benefits.

Lithium
Taking lithium during pregnancy can cause heart problems in the foetus. Lithium should be not be taken when you are pregnant if possible.

Valproate
Valproate can harm an unborn baby. It can cause birth defects such as:

  • spina bifida,
  • problems with forming the face and skull, and
  • problems forming the limbs, heart, kidney, urinary tract and sexual organs.

It can also cause developmental and learning problems such as:

  • being late in learning to walk and talk,
  • lower intelligence than other children of the same age,
  • poor speech and language skills, and
  • memory problems.

Children are also more likely to have autism or autistic spectrum disorders and signs of Attention Deficit Hyperactivity Disorder (ADHD).

Lamotrigine
NICE guidleines say that you should tell your doctor if you are pregnant and taking lamotrigine.

Antipsychotics
NICE guidance recommends antipsychotics that are used as mood stabilisers are better than other mood stabilisers if you are pregnant.

Breast feeding

NICE guidelines recommed that antipsychotics are used as mood stabilisers whilst breast feeding. Speak to your doctor about this.

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