Understanding Antidepressants, Part 4: What Are Mood Stabilizers and How Do They Work?
By Tannia Salazar, APRN | Rooted in Serenity Behavioral Health 🌿
When mood feels unpredictable—persistent anxiety, lingering depression, or sudden shifts—sometimes antidepressants alone aren’t enough. That’s when we may talk about mood stabilizers.
Mood stabilizers aren’t just one medication. They’re a group of treatments that help smooth out the ups and downs, supporting steadier emotions and reducing the risk of relapse.
In this post, I’ll explain what mood stabilizers are, how they work, and what to expect if you start one.
What Are Mood Stabilizers?
Mood stabilizers are medications that help reduce mood swings and support emotional balance when symptoms don’t fully respond to first-line antidepressants. While they are sometimes used for bipolar disorder, they can also play an important role in treating treatment-resistant depression and certain cases of anxiety—especially when mood feels unpredictable or when standard medications haven’t been enough.
Who Might Benefit?
Your provider may suggest a mood stabilizer if:
You have treatment-resistant depression (antidepressants alone haven’t given enough relief)
You live with persistent or intrusive anxiety that hasn’t improved with standard approaches
You experience mood instability that complicates recovery from anxiety or depression
You’ve had side effects or limited benefit from other antidepressant classes
Common Mood Stabilizers
Here are some you may hear about in the treatment of anxiety and depression:
Lamotrigine (Lamictal®) – often used as an add-on when antidepressants haven’t been enough. Can reduce depressive symptoms and sometimes ease anxiety.
Lithium – sometimes added in treatment-resistant depression to boost the effect of antidepressants.
Valproate (Depakote®) – less commonly used for depression, but can help in some cases where mood feels highly unstable.
Carbamazepine (Tegretol®) – not usually a first choice, but occasionally considered when other options don’t work.
Some atypical antipsychotics (like quetiapine or aripiprazole) are also considered mood stabilizers because of how they regulate mood.
How Long Do Mood Stabilizers Take to Work?
Lamotrigine → Often takes longer—several weeks—but can be especially helpful in preventing ongoing depressive episodes.
Lithium and valproate → May start improving symptoms within days to weeks.
Consistency is key. These aren’t “quick fixes,” but over time they can reduce the frequency and intensity of mood symptoms and help restore balance.
Common Side Effects
Every medication has potential side effects. With mood stabilizers, many improve over time—but some require careful monitoring.
Here’s a simple guide:
| Side Effect | How It Might Feel | What to Expect / When to Reach Out |
|---|---|---|
| Tremor | Subtle hand shaking, often with lithium | Common; may improve with dose adjustment. Call if worsening. |
| Weight changes | Increased appetite or gradual weight gain (more with valproate, lithium) | Monitor; talk to your provider if changes feel significant. |
| GI upset | Nausea, stomach discomfort, or loose stools | Often temporary. Take with food. Call if severe or persistent. |
| Fatigue or drowsiness | Feeling tired, groggy, or slowed down | May improve as your body adjusts. Call if it interferes with daily life. |
| Skin rash | New rash, especially with lamotrigine | Call right away. Rare, but sometimes serious. |
| Thirst & urination changes | Feeling more thirsty or frequent bathroom trips (lithium) | Monitor hydration. Call if extreme or paired with confusion/weakness. |
Important Monitoring
Some mood stabilizers require regular bloodwork. This ensures both safety and effectiveness over time.
Here’s a simple chart:
| Medication | What to Monitor | Why It Matters |
|---|---|---|
| Lithium | Lithium blood level, kidney function (BUN/creatinine), thyroid tests (TSH ± T4) | Keeps the dose in a safe range and protects long-term kidney and thyroid health. |
| Valproate (Depakote®) | Blood level, liver function tests, platelets | Ensures the medication is effective while protecting the liver and blood health. |
| Carbamazepine (Tegretol®) | Blood level, liver function, complete blood count (CBC) | Prevents rare but serious effects on the liver or bone marrow. |
| Lamotrigine (Lamictal®) | No routine labs; careful dose titration and monitoring for rash | Rash is the main concern—slow increases in dose reduce risk. |
What Mood Stabilizers Don’t Do
They don’t erase your personality.
They don’t eliminate all emotions.
They don’t provide instant calm.
What they do is reduce the intensity of mood fluctuations—giving you steadier ground to build therapy, coping skills, and relationships.
Final Thoughts
Mood stabilizers can be life-changing for people living with stubborn depression or ongoing anxiety. While they require monitoring and patience, the stability they provide can open doors to deeper healing.
For some, mood stabilizers not only reduce mood fluctuations but also ease the constant edge of anxiety. They aren’t considered a first-line treatment for anxiety, but when carefully chosen, they can play a supportive role in calming both mood and mind—especially when other medications haven’t been enough.
If you’ve been struggling with depression or anxiety that hasn’t improved with standard treatments, mood stabilizers may be worth exploring. Together, we’ll look at whether this option makes sense for your unique story.
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📖 Read more about Tannia Salazar, APRN
📖 Interested in reading the whole series:
Understanding Antidepressants, Part 1: What Are SSRIs and How Do They Work?
Understanding Antidepressants, Part 2: What Are SNRIs, and How Do They Work?
Understanding Antidepressants, Part 3: What are Atypical Antidepressants and How Do They Work?
Understanding Antidepressants, Part 5: Augmentation Strategies for Treatment-Resistant Depression
🌿 Tannia Salazar, APRN, Founder of Rooted in Serenity Behavioral Health LLC, offering telepsychiatry services across Connecticut for adults navigating anxiety, ADHD, trauma, and more.
