There are several mood stabilisers, some of which are also used to treat epilepsy or to help with schizophrenia8. Your psychiatrist may need to use more than one medication to control mood swings effectively9.

Lithium

Lithium has been used as a mood stabiliser for decades – but how it works is still not clear. It is still the first choice for long-term treatment of bipolar disorder and can be used to treat both manic and depressive episodes.

Treatment with lithium should be started by a psychiatrist. The difficulty is getting the level of lithium in the body right – too low and it won't work, too high and it can harm you. So, you will need regular blood tests in the first few weeks to make sure that you are getting the right dose1 10. Once the dose is stable, your GP can prescribe your lithium and arrange regular blood tests for the longer term.

The amount of lithium in your blood is very sensitive to how much, or how little, water there is in your body. If you become dehydrated, the level of lithium in your blood will rise, and you will be more likely to get side-effects, or even toxic effects1. So, it’s important to:

drink plenty of water – more in hot weather or when you are active

be careful with tea and coffee - they increase the amount of water you pass in your urine.

It can take three months or longer for lithium to work properly. It's best to carry on taking the tablets, even if your mood swings continue during this time.

Side-effects

These can start in the first few weeks after starting lithium treatment. They can be irritating and unpleasant, but often disappear or get better with time.

They include:

feeling thirsty.

passing more urine (and more often) than usual.

weight gain.

Less common side-effects are:

blurred vision.

slight muscle weakness.

occasional diarrhoea.

fine trembling of the hands.

a feeling of being mildly ill.

These can usually be improved by lowering the dose of lithium.

The following signs suggest that your lithium level is too high. Contact your doctor immediately if you notice:

you feel very thirsty.

you have bad diarrhoea or vomiting.

obvious shaking of your hands and legs.

twitching of your muscles.

you get muddled or confused.

Blood and urine tests

At first you will need blood tests every few weeks to make sure that you have the right level of lithium in your blood. You will need these tests for as long as you take lithium, but less often after the first few months.

Long-term use of lithium can affect the kidneys or the thyroid gland. You will need to have blood and urine tests every few months to make sure that these organs are still working properly. If there is a problem, you may need to stop lithium and discuss an alternative with your doctor.

Taking care of yourself5

Eat a well-balanced diet.

Drink unsweetened fluids regularly. This helps to keep your body salts and fluids in balance. Steer clear of colas and soft drinks with a lot of sugar in them.

Eat regularly - this will also help to maintain your fluid balance.

Watch out for caffeine – in tea, coffee or cola. This makes you urinate more, and so can upset your lithium level.

Other mood stabilisers

There are other medications, apart from lithium, that can help. How these are used will depend on whether it is for a manic or depressive swing, or to stop these from happening – and whether the person is already taking an antidepressant.

Anti-epileptic medications/anticonvulsants : Sodium valproate, an anti-convulsant, may work just as well as lithium, but we don’t yet have enough evidence to be sure. It should not be prescribed to women of child-bearing age (NICE, 2014). Carbamazepine and lamotrigine are also effective for some people.

: Antipsychotic medications: Haloperidol, olanzapine, quetiapine and risperidone.

When to start a mood stabiliser

After just one episode, it’s difficult to predict how likely you are to have another. Some people don’t want to start a mood stabiliser at this stage, but episodes of mania can be severe and very disruptive.

If you have a second episode, there is a strong chance of further episodes. So, at this point, a mood stabiliser would be more strongly recommended.

For how long should someone take a mood stabiliser?

For at least:

Two years after one episode of bipolar disorder.

Five years if there have been: frequent previous relapses psychotic episodes alcohol or substance misuse continuing stress at home or at work.



If you do decide to stop your medication, you should discuss this with your doctor. It’s usually best to carry on seeing your psychiatrist for 2 years after stopping medication for bipolar disorder, so that they can check you for any signs of relapse.

If you continue to have troublesome mood episodes, you may need to continue medication for longer.

More information about other mood stabilisers can be found in our online information on Medications for Bipolar Disorder.