Ad

Mood Stabilizers for Major Depression

Brindusa Vanta, MD, DHMHS
Medical editor

Ad Disclosure: Some of our MentalHelp.net recommendations, including BetterHelp, are also affiliates, and as such we may receive compensation from them if you choose to purchase products or services through the links provided

What Mood Stabilizers Are Prescribed to Treat Depression?

While mood stabilizers are not considered first-line treatments for depression alone, they may be prescribed to manage bipolar depression or treatment-resistant depression. Mood stabilizers for these types of depression may include:[1],[2],[3]

  • Lithium
  • Lamotrigine (Lamictal)
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Oxcarbazepine (Trileptal)

Everyone’s needs are different, which is why professional oversight and individualized treatment planning is so important.

Mood stabilizers are prescription medications used to help manage mood swings and stabilize emotions in conditions like bipolar disorder, which involves alternating periods of depression and mania. 

Ad

Mood stabilizers are also sometimes used to treat depression that does not respond well to other medications, a condition known as treatment-resistant depression. These medications, including lithium, lamotrigine, and valproate, help stabilize mood and reduce symptoms of depression in individuals with bipolar disorder or treatment-resistant depression.[1],[2],[3]

Mood stabilizers differ from antidepressants, which are medications specifically designed to alleviate symptoms of depression by targeting neurotransmitters such as serotonin and norepinephrine in the brain. While antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat depression, they may not be suitable for those with bipolar disorder because they can trigger manic episodes. 

Therapists are Standing By to Treat Your Depression, Anxiety or Other Mental Health Needs

Explore Your Options Today

Ad

Mood stabilizers, on the other hand, are better suited for managing mood swings and stabilizing emotions in bipolar disorder, as they help prevent both depressive and manic episodes.[1],[2],[3]

As Dr. Brindusa Vanta, MD, says, "Besides helping stabilize mood, some mood stabilizers provide extra benefits, such as neuroprotective effects or supporting the brain's ability to adapt and form new neuronal connections through a process called neuroplasticity."

Lithium: A Focused Overview

Lithium is a medication commonly used to treat depressive episodes in bipolar disorder. It helps stabilize mood and reduce the intensity and frequency of depressive symptoms, promoting a more balanced emotional state.[4]

Lithium modulates certain neurotransmitters in the brain, including serotonin and norepinephrine, by altering their release and reuptake processes in the brain. By regulating neurotransmitter activity, lithium helps stabilize mood and reduce symptoms of depression.[6]

Side Effects

As with all medications, lithium can cause potential side effects, such as [4],[5]

  • Increased thirst and urination
  • Weight gain
  • Hand tremors
  • Nausea and vomiting
  • Diarrhea
  • Impaired memory
  • Thyroid problems
  • Kidney problems

Because of the risk and side effects of lithium, monitoring of lithium levels in the blood is crucial to prevent toxicity. Blood tests are regularly conducted to ensure lithium levels remain within the therapeutic range.[7]

Full Lithium Responders

While many people can benefit from lithium for bipolar depression or treatment-resistant depression, some people stabilize extremely well on this medication—they are called complete or full responders. Typically, lithium responders tend to be those who have:[8]

  • A family history of a good response to lithium
  • Typical symptoms of bipolar disorder
  • The absence of co-occurring medical or psychiatric conditions
  • Good compliance with treatment

Lithium’s Anti-Suicide Effects

Lithium is a unique mood stabilizer in that it has specific anti-suicidal benefits—it can reduce suicidal behavior and ideation, particularly in individuals with mood disorders. It is considered one of the most effective medications for preventing suicide in patients with bipolar disorder.[9]

How Effective Are Mood Stabilizers for Depression?

The category of mood stabilizers is very broad. As such, every mood stabilizer has shown different rates of efficacy. 

Lithium Efficacy

Lithium, in particular, has shown great effectiveness in treating depression associated with bipolar disorder.

One review and meta-analysis on the efficacy of lithium for bipolar disorder found that about 66% of participants experienced significant improvement in depressive or manic symptoms, with over half achieving remission. However, about 50% needed additional treatment to maintain improvements or experienced a recurrence of bipolar symptoms.[10]

Another meta-analysis reported that lithium is associated with a reduction in depressive relapse rates by up to 50% compared to placebo or other medications, leading to improved quality of life and improved functioning.[11]

Lamotrigine Efficacy

Lamotrigine is effective in treating depressive episodes in bipolar disorder, with studies showing improvements in mood and a reduced risk of relapse compared to placebo.[12]

Valproate Efficacy

Research on the effectiveness of valproate for bipolar depression or treatment-resistant depression is somewhat limited compared to other mood stabilizers like lithium or lamotrigine. While valproate is commonly used as a mood stabilizer in bipolar disorder, its efficacy specifically for treating depressive episodes is not as well-established.

A systematic review and meta-analysis found limited evidence supporting the use of valproate for acute depressive episodes in bipolar disorder. The study concluded that while valproate may have some efficacy in treating acute mania, its effectiveness for depressive episodes is uncertain due to the lack of robust clinical trials and inconsistent findings across studies.[13]

Overall, while valproate may be effective in managing manic symptoms in bipolar disorder, its role in treating bipolar depression or treatment-resistant depression is less clear. 

As Dr. Brindusa Vanta, MD, says, "Some antipsychotics are also used as mood stabilizers. They can be used in combination with other mood-stabilizing drugs or alone to stabilize the mood in bipolar disorder. Examples of antipsychotics used in bipolar depression include clozapine, risperidone, and quetiapine."

Additional Resources

As advocates of mental health and wellness, we take great pride in educating our readers on the various online therapy providers available. MentalHelp has partnered with several thought leaders in the mental health and wellness space so we can help you make informed decisions on your wellness journey. MentalHelp may receive marketing compensation from these companies should you choose to use their services.

MentalHelp may receive marketing compensation from the above-listed companies should you choose to use their services.

Resources 

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Rybakowski J. K. (2023). Mood Stabilizers of First and Second Generation. Brain sciences, 13(5), 741. https://doi.org/10.3390/brainsci13050741
  3. Gould, T. D., Chen, G., & Manji, H. K. (2002). Mood stabilizer psychopharmacology. Clinical neuroscience research, 2(3-4), 193–212. https://doi.org/10.1016/S1566-2772(02)00044-0
  4. Nath M, Gupta V. Mood Stabilizers. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556141/
  5. National Institute of Mental Health. (2023). Mental Health Medications.
  6. Machado-Vieira, R., Manji, H. K., & Zarate, C. A., Jr (2009). The role of lithium in the treatment of bipolar disorder: convergent evidence for neurotrophic effects as a unifying hypothesis. Bipolar disorders, 11 Suppl 2(Suppl 2), 92–109. https://doi.org/10.1111/j.1399-5618.2009.00714.x
  7. National Institute of Mental Health. (2021, August). Bipolar disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  8. Alda M. (2017). Who are excellent lithium responders, and why do they matter? World psychiatry: official journal of the World Psychiatric Association (WPA), 16(3), 319–320. https://doi.org/10.1002/wps.20462
  9. Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ (Clinical research ed.), 346, f3646. https://doi.org/10.1136/bmj.f3646
  10. Ulrichsen, A., Hampsey, E., Taylor, R. H., Gadelrab, R., Strawbridge, R., & Young, A. H. (2023). Comparing measurements of lithium treatment efficacy in people with bipolar disorder: systematic review and meta-analysis. BJPsych Open, 9(3), e98. https://doi.org/10.1192/bjo.2023.64
  11. Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Frontiers in psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377
  12. Geddes, J. R., Miklowitz, D. J., & Carney, S. M. (2016). Lithium and mood stabilizers. In J. R. Geddes, M. Priest, & A. M. Goodwin (Eds.), Oxford textbook of mood disorders (2nd ed., pp. 431-441). Oxford University Press.
  13. Cipriani, A., Barbui, C., Salanti, G., Rendell, J., Brown, R., Stockton, S., & Geddes, J. R. (2013). Comparative efficacy and acceptability of antimanic drugs in acute mania: A multiple-treatments meta-analysis. The Lancet, 381(9869), 1306-1315. 

Additional Resources

As advocates of mental health and wellness, we take great pride in educating our readers on the various online therapy providers available. MentalHelp has partnered with several thought leaders in the mental health and wellness space, so we can help you make informed decisions on your wellness journey. MentalHelp may receive marketing compensation from these companies should you choose to use their services.

MentalHelp may receive marketing compensation from the above-listed companies should you choose to use their services.

Ad