"What Is a Mood Stabiliser?" Understanding Medication for Bipolar Disorder and Mood Episodes

The term mood stabiliser sounds fairly self-explanatory, but in practice it can be confusing.

People sometimes assume that these medications simply make emotions less intense or prevent someone from feeling very happy or very sad. Others worry that taking a mood stabiliser will flatten their personality and leave them feeling emotionally numb.

That is not the aim of treatment.

When we use mood-stabilising medication, we are not trying to remove the normal emotional changes that are part of everyday life. We are trying to prevent or treat significant episodes of illness, particularly the episodes of mania, hypomania and depression that can occur in bipolar disorder.

The distinction between normal emotions and episodes of illness is important because good treatment should help someone live their life rather than make them feel less of it.

What Do We Mean by a Mood Stabiliser?

Interestingly, "mood stabiliser" is not one single type of medication.

The term is used to describe medicines that can help treat or prevent episodes of abnormal mood.

Lithium is probably the medication most strongly associated with the term. Certain anticonvulsant medications, including Lamotrigine and Valproate, may also be used in the treatment of bipolar disorder.

Some antipsychotic medications also have important mood-stabilising effects and are commonly used in bipolar disorder.

These medications are not interchangeable. Their benefits, risks and monitoring requirements differ and some are better suited to particular phases or patterns of illness than others.

The choice of medication therefore depends on the individual rather than simply the diagnosis written in their notes.

Why Would Someone Need One?

Mood stabilisers are most commonly associated with bipolar disorder.

Someone experiencing mania may become unusually energetic or irritable, sleep very little, speak much more than usual, develop racing thoughts or make impulsive and potentially risky decisions.

At the other end of the spectrum, they may experience significant episodes of depression.

Treatment therefore has two possible jobs.

The first is treating an episode that is happening now.

The second is reducing the likelihood of another episode occurring in the future.

For many people, that preventative role is particularly important.

What Should Successful Treatment Feel Like?

People sometimes expect to "feel" a mood stabiliser working in the same way they might notice a painkiller relieving a headache.

Often, successful treatment is much less obvious.

Someone who has experienced repeated mood episodes may gradually notice that their life has become more predictable. They are sleeping consistently, functioning well and going for longer periods without becoming significantly depressed or elevated.

Nothing dramatic is happening.

That is often precisely the point.

With preventative treatment, success can sometimes be measured by the episodes that don't happen.

Will It Flatten My Emotions?

This is an understandable concern.

Normal mood varies.

We should feel excited when something wonderful happens and sad when something painful occurs. Medication should not remove that.

Some people do experience unwanted effects such as sedation, cognitive slowing or a sense of emotional blunting with particular medications or doses. If this happens, it deserves discussion with the prescriber.

Sometimes the dose needs reviewing or another treatment may offer a better balance.

The goal should be stability rather than emotional flatness.

Being stable does not mean feeling the same every day.

It means that normal emotional experiences are not repeatedly developing into episodes of illness.

Why Does Lithium Need Blood Tests?

Lithium is an effective treatment for bipolar disorder but requires careful monitoring.

The amount of Lithium in the bloodstream needs to remain within an appropriate range. Too little may not provide sufficient benefit while excessively high levels can be harmful.

This is why people taking Lithium have regular blood tests to measure the level of medication in their blood. Kidney and thyroid function also need monitoring because Lithium can affect both over time.

There are also circumstances that can alter Lithium levels, including dehydration, significant changes in fluid or salt intake and interactions with certain other medicines.

Patients taking Lithium should therefore receive specific information about how to use it safely and what symptoms require medical advice.

Monitoring is not a sign that Lithium is an inherently "bad" medication.

It is what allows us to use an effective medication safely.

Different Mood Stabilisers Need Different Monitoring

Not every mood-stabilising medication requires the same checks.

Some require blood tests. Others require monitoring for particular side effects or careful attention when the medication is first introduced.

There can also be important considerations around pregnancy and contraception with some treatments. Valproate in particular is subject to major safety restrictions because of the significant risks associated with exposure during pregnancy.

This is why medication decisions need to take account of much more than whether a drug is capable of treating someone's symptoms.

Age, physical health, other medications, previous treatment response and reproductive considerations may all influence what is appropriate.

Why Continue Medication When I'm Well?

This can be one of the hardest aspects of preventative treatment to understand.

When somebody has been stable for a long time, it is natural to wonder whether they still need medication.

The difficulty is that being well may be evidence that treatment is doing exactly what it was intended to do.

For someone who has experienced significant episodes of mania or depression, stopping effective medication can increase the risk of relapse.

This does not mean medication should never be reviewed.

It should.

The benefits and disadvantages of longer-term treatment should be discussed periodically and decisions should take account of the person's history and preferences.

However, stopping medication simply because things are currently going well can sometimes remove the very thing that has helped maintain that stability.

Medication Is Only Part of Staying Well

Mood stabilisers can be extremely important, but medication is not the whole picture.

Sleep is particularly relevant in bipolar disorder. Significant disruption to sleep can sometimes accompany or precede changes in mood.

Learning to recognise personal early warning signs can also be valuable.

For one person, that might be needing much less sleep. For another, it could be becoming unusually productive, spending more money or starting numerous projects at once.

Psychological support, regular routines, managing stress and involving trusted family members or partners where appropriate can all form part of a broader plan for staying well.

Medication works best when it sits within that wider understanding of the person's life and illness.

A Final Thought

The phrase "mood stabiliser" can give the impression that psychiatric medication is designed to keep someone permanently in the emotional middle.

That is not what we are trying to achieve.

People should still experience happiness, excitement, disappointment, frustration and sadness. These emotions are part of a healthy life.

The purpose of mood-stabilising treatment is different.

For someone vulnerable to significant episodes of mania, hypomania or depression, it can help create something that may have been missing for a long time: stability.

Sometimes the benefit of medication is obvious because a distressing symptom disappears.

With preventative treatment, the benefit can be quieter.

Another year without a manic episode.

Another period of work that wasn't interrupted by severe depression.

Relationships that have had time to recover.

Plans that can finally be made with greater confidence.

Those changes may be less immediately visible than the effect of a medication taken for an acute symptom, but for somebody living with a recurrent mood disorder, they can be enormously important.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry