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Mood stabilisers are a type of medicine that can help with depression, mania or rapid mood swings. The best known mood stabiliser is lithium, which is often prescribed for the treatment of bipolar mood disorder (also known as manic depressive disorder).

Mood stabilisers can help control and sometimes reduce mood swings. People with both depressive and manic and/or psychotic problems, often come to rely on this type of medicine. It is often prescribed to prevent problems after the first psychiatric episode or crisis. To prevent such a crisis from happening again, long-term use of this medicine is advised.

Example: people who have a combination of psychosis vulnerability and mood problems (for instance, diagnosed with bipolar mood disorder or manic depression), can benefit from this type of medicine. Mood stabilisers reduce the euphoria that can develop during (hypo)mania, thereby preventing psychosis. The medication acts as a kind of “barrier”, so that someone in a manic state is kept from falling into psychosis. How exactly these medications work is not known.

Types of mood stabilisers [trade name] (and their active ingredient):

  • Lithium [Priadel, Camcolit, Litarex] (lithium carbonate);
  • Carbamazepine [Tegretol, Carbymal];
  • Valproate [Depakine, Convulex, Propymal (valproic acid);
  • Lamictal [Lamictal] (lamotrigine).

Lithium poisoning

Too much lithium in the blood can lead to lithium poisoning (also called lithium toxicity). This is a serious state that can cause permanent damage and thus requires immediate action. Lithium toxicity can develop slowly. Sometimes other people around the lithium user notice it before the user does. If the dosage has not changed recently, the poisoning is usually caused by dehydration and salt depletion. It can also be caused by taking too much lithium. Lithium toxicity can be prevented through careful use of the medication and by having your lithium level tested regularly.

The risk of lithium toxicity increases in the following situations:

  • Diarrhoea and/or vomiting;
  • Losing bodily fluids from sweating (because of exercise, a sauna, warm weather, etc.) and not drinking enough;
  • Low-salt diet or an extreme diet;
  • Loss of appetite, for instance during illness or high fever;
  • Use of certain medication such as diuretics, certain pain medicines (though not paracetamol, also known as acetaminophen), certain medicines against high blood pressure and certain antibiotics.

How to recognise lithium toxicity?

With lithium toxicity you can notice an increase of “regular” side effects such as:

  • Shaking, nausea, vomiting, stomach cramps and diarrhoea;
  • Difficulties concentrating, sluggishness, slow responses, drowsiness and sleepiness;
  • Heaviness of arms and legs, muscle weakness;
  • “Drunken gait” and/or slurred speech;
  • Confusion, spasms and seizures.

If you show one or more of these symptoms, lithium use must be stopped at least temporarily and the psychiatrist and/or general practitioner must be notified. Additionally, you can start restoring salt and fluid levels, for instance by having one or two cups of broth.

Lithium and blood tests

When using lithium, regular tests are required to check if the lithium levels in your blood are not too high or too low (weekly tests at first, then monthly and eventually once every 3 to 6 months). Concentrations between 0.6 – 0.8 millimoles per litre are considered normal. However, sometimes people function very well with a lower level. A vial of blood has to be drawn within twelve hours, give or take one hour, after the most recent dose of lithium. Through the blood tests, the kidney and thyroid functions are also checked. Additionally, your body weight is being monitored as well.

What medicine works best?

Each body is different and everyone responds to medication differently. Through good cooperation between you and the psychiatrist, therapist and/or community psychiatric nurse, treatment can be continuously improved. On the one hand, it is important that the medicine is effective. On the other hand, this effectiveness should outweigh the negative consequences of the medication, such as side effects.

Side effects

The purpose of the medication is to reduce or eliminate symptoms. But at the same time, taking medication can also cause new problems and symptoms. Read the patient information leaflet carefully to know the possible side effects of your specific medicine. Common examples of side effects from mood stabilisers are: weight gain, nausea, tremor (such as hands shaking), irritated skin, liver and kidney problems, sleepiness, apathy, muscle stiffness and even depression and suicidal thoughts.

Quitting the use of mood stabilisers

If someone wants to stop using mood stabilisers, it is important to do this in consultation with the therapist prescribing the medication. To prevent your problems for returning, reduction must be done responsibly. Having someone who keeps an eye on the process to prevent relapse is also important. Suddenly stopping mood stabilisers can also cause withdrawal symptoms. In order to reduce medicine use responsibly and carefully, your pharmacist can prepare adjusted dosages in a tapering strip.

Prof. dr. Jim van OsChair Division Neuroscience, Utrecht University Medical Centre. Jim is also Visiting Professor of Psychiatric Epidemiology at the Institute of Psychiatry in London. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. 

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