What are Mood Stabilizers & Lithium?
Mood stabilizers are medications used primarily to prevent and treat the mood episodes of bipolar disorder — both manic/hypomanic and depressive episodes. Lithium is the longest-established and most extensively studied mood stabilizer, with strong evidence for both treating acute mania and, importantly, reducing the risk of future episodes and suicide risk over the long term. Other medications used as mood stabilizers include certain anticonvulsants (such as valproate and lamotrigine), which affect mood through different mechanisms than lithium.
Common indications
- Bipolar I and bipolar II disorder — acute mania and long-term relapse prevention
- Treatment-resistant depression, as an add-on to an antidepressant, in some cases
- Schizoaffective disorder, bipolar type
- Reducing suicide risk in mood disorders (specifically established for lithium)
Common side effects
- Lithium: increased thirst and urination, fine hand tremor, mild nausea, weight gain
- Lithium: changes in thyroid or kidney function over long-term use, monitored via regular blood tests
- Valproate: weight gain, hair thinning, tremor, sedation
- Lamotrigine: skin rash (usually mild, but requires immediate medical attention if severe — see urgent care)
- General: sedation or reduced alertness, particularly when treatment is first started or the dose is adjusted
Precautions and warnings
- Lithium requires regular blood tests to monitor lithium levels, kidney function and thyroid function, since the effective dose range is relatively narrow and both too little and too much can be a problem
- Dehydration, certain other medications (including some painkillers and blood pressure medications), and reduced salt intake can all affect lithium levels — this is discussed as part of ongoing monitoring
- Valproate carries significant risk in pregnancy and is generally avoided in women who could become pregnant unless no suitable alternative exists, under specialist guidance
- Lamotrigine dose must be increased very gradually according to a specific schedule to reduce the risk of serious rash
- Regular follow-up and blood testing is a core, non-optional part of safe mood stabilizer treatment, not an occasional extra
How long does it take to work?
For acute mania, some effect can be seen within one to two weeks, with fuller control often taking several weeks. For relapse-prevention (the primary long-term goal, particularly with lithium), benefit builds over months, and the medication's real value is often best judged over a longer period of stability rather than a short trial.
Stopping or changing this medication
Mood stabilizers, particularly lithium, should not be stopped abruptly, since doing so — especially suddenly — is associated with a notably increased risk of relapse, including rebound mania. Any decision to reduce or stop a mood stabilizer is made collaboratively with a psychiatrist, typically with a slow taper and close monitoring.
When to seek urgent care
Seek urgent medical care for signs of lithium toxicity (severe tremor, confusion, slurred speech, vomiting, unsteady walking — particularly after illness, dehydration or a dose change), any severe or spreading skin rash while taking lamotrigine, or any new severe abdominal pain, jaundice or bleeding while taking valproate.
Why treatment is individualized
Choice of mood stabilizer, dosing, and monitoring schedule are individualised based on diagnosis, other health conditions, pregnancy plans, and response and tolerability. This page provides general education, not a recommendation for what any specific person should take.
Frequently asked questions
Why does lithium need regular blood tests?
Lithium works within a relatively narrow effective range — too low and it may not control symptoms, too high and it can become toxic. Regular blood tests confirm the level is in the safe, effective range and also monitor kidney and thyroid function, which lithium can affect over long-term use.
Is lithium an old, outdated medication?
No — despite being one of the oldest psychiatric medications still in use, lithium remains one of the most effective treatments for bipolar disorder, with the strongest evidence of any mood stabilizer for reducing suicide risk specifically, which is why it remains a first-line option.
Can mood stabilizers be taken during pregnancy?
This requires individual, careful discussion with a psychiatrist — some mood stabilizers (particularly valproate) carry significant risks in pregnancy, while decisions about others depend on the specific situation, balancing medication risk against the risk of an untreated mood episode. This should always be planned in advance where possible, not decided during an unplanned pregnancy.
What happens if I miss a dose of lithium?
An occasional missed dose is not usually dangerous, but consistent, regular use is important for maintaining a stable level. Do not take a double dose to make up for a missed one without guidance — ask your prescriber for specific advice.
How long is mood stabilizer treatment usually needed?
For bipolar disorder, long-term maintenance treatment is often recommended given the high risk of relapse without it, though this is an individualised decision reviewed periodically based on episode history and personal circumstances, not a fixed universal duration.
References
- National Institute for Health and Care Excellence (NICE). Bipolar disorder: assessment and management.
- Royal College of Psychiatrists. Lithium patient information.
- British Association for Psychopharmacology. Guidelines for treating bipolar disorder.
Have questions about your medication?
Book a consultation to discuss whether this or another treatment is right for your specific situation.