Short answer: mood stabilizers reduce the highs and lows of bipolar disorder and help prevent future episodes. The main options are lithium, certain anticonvulsants (such as lamotrigine and valproate) and some second-generation antipsychotics. Each has different strengths, side effects and monitoring needs.
Lithium
Lithium has the longest track record and strong evidence for preventing both mania and depression, as well as lowering suicide risk. It requires regular blood tests to keep levels in a safe range and to check kidney and thyroid function. Staying hydrated and avoiding certain pain relievers (such as ibuprofen) without checking first is important.
Lamotrigine
Lamotrigine is especially useful for preventing bipolar depression. It is started slowly over several weeks to lower the risk of a rare but serious rash; any new rash should be reported right away.
Valproate
Valproate helps with mania and mixed episodes. It needs blood monitoring and is generally avoided in people who could become pregnant because of risks to a developing baby.
Second-generation antipsychotics
Several of these medications treat mania, bipolar depression or both, and can be used alone or with another mood stabilizer. Monitoring focuses on weight, blood sugar and cholesterol.
Questions to ask your psychiatrist
- Which option fits my main pattern: more highs or more lows?
- What blood tests will I need, and how often?
- How does this fit with pregnancy plans or birth control?
- What early warning signs should prompt a call?
Finding the right fit takes partnership
Many people with bipolar disorder try more than one medication before finding the right balance. Your input matters: which side effects you can live with, how the medication fits your work and family life, and your plans for pregnancy. Being honest about missed doses is important too, because inconsistent use is one of the most common reasons for relapse.
Early warning signs plan
A written plan helps you and your family respond quickly to changes. It usually lists your personal early signs of a high (sleeping less, talking faster, spending more) and of a low (withdrawing, sleeping more, losing interest), the steps you will take, and when to contact your psychiatrist. Acting early often prevents a full episode.
Lifestyle supports
Regular sleep and wake times, limiting alcohol and avoiding drugs, managing stress, and keeping a mood log all make medication more effective. Some people find mood-tracking apps useful for spotting patterns to discuss at appointments.
Frequently asked questions
Will I need to take a mood stabilizer for life?
Bipolar disorder is usually long-term, and ongoing treatment greatly lowers relapse risk. Any changes should be planned together.
Can I drink alcohol?
Alcohol can destabilize mood and interact with medications, so it is best limited or avoided.
Learn more about bipolar disorder diagnosis and treatment or schedule medication management with Psych Boston. Request an appointment.
Related reading: Alcohol and Anxiety: Why a Drink Can Make Tomorrow Worse · Depression in Older Adults: Signs Families Often Miss
This article is general information, not medical advice. If you are in crisis, call or text 988 or call 911. Psych Boston is an outpatient psychiatry practice at 35 Bedford St #17, Lexington, MA781-218-9550).