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What role can mood stabilizers such as lithium, which are more commonly prescribed to people with bipolar disorder, play in the treatment of major depression?

The main treatments for major depressive disorder — a leading cause of disability in the US — are talk therapy and antidepressant medications. Both can, alone or together, help some people overcome their depression. Antidepressant medications aren't always effective, however, as research shows that approximately 40 percent of people with major depressive disorder don't improve to the point that they are no longer depressed while they take antidepressants. 

This presents a real treatment dilemma, and medications that do not fall into the category of antidepressants may be considered in some cases. These include bezodiazepines and ketamine, but also so-called mood stabilizers. What are those, what are they usually used for, why might your doctor prescribe them for depression, and what what kinds of side effects do they produce?

What are mood stabilizers? What are they used for?

There is actually some debate about this. In general, though, a specific number of psychiatric medications that stabilize the mood, by fighting mania, hypomania, and depression, are considered mood stabilizers. Lithium, which is available under many different brand names, including Camcolit, Lithonate, Liskonum, Priadel, Litarex, and Li-liquid, is the most well-known as well as oldest of these. 

Other mood stabilizers are:

  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Valproate (Epilim, Depakote)
  • Asenapine (Sycrest)
  • Topiramate (Topamax)

These medications are, as mood stabilizers (many are also anticonvulsants) mostly prescribed to people with bipolar disorder, some other mental disorders that induce mood swings (such as schizoaffective disorder), and alongside antidepressants in depressed patients who do not respond well to those alone. 

Why might mood stabilizers be prescribed to a person with major depressive disorder?

Though bipolar disorder, previously referred to as manic depression, features depressive symptoms and mood stabilizers are an effective treatment for bipolar disorder, these medications are not typically prescribed to people suffering from major depressive disorder ("unipolar" depression). Antidepressants would, rather, be the first pharmacological treatment of choice. And in today's world, a very broad spectrum of antidepressants is available, ranging from the older monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants to the newer selective serotonin reuptake inhibitors (SSRIs) and selective serotonin noradrenaline reuptake inhibitors (SSNRIs). 

Should this antidepressant therapy, ideally in combination with a form of talk therapy like cognitive behavioral therapy or psychodynamic therapy, be successful, mood stabilizers will not be necessary and will not be considered. 

For the around four in 10 depressed people — or, according to some research, even more, and in fact up to two thirds — who don't get better even after a trial with two different carefully-selected antidepressant medications, however, the story is different. Mood stabilizers may be an option for these people.

Lithium will often be the medication of choice in this case, and its use has been shown to significantly increase remission rates in people dealing with this kind of treatment-resistant depression, meaning the depression is under control. Mood stabilizers may be especially helpful to people with treatment-resistant depression who are suicidal. 

Some studies, in fact, recommend that depressed people who simply aren't responding to antidepressant medications shouldn't be "strung along" with trials of numerous different antidepressants that don't have any measurable effect. They should, rather, be put on a mood stabilizer sooner rather than later, according to this view. In such cases, they will usually still be combined with some kind of antidepressant.

What kinds of side effects can mood stabilizers have?

The side effects will vary from medication to medication, as well as from person to person. However, some of the mental and physical side effects that are possible while taking mood stabilizers include:

  • Nausea and possible vomiting
  • More frequent urination
  • Being very thirsty
  • Shakiness of the hands
  • A skin rash along with itchiness
  • Speech changes, such as slurred speech
  • A rapid, irregular, or slow heart beat
  • Clumsiness
  • Seizures
  • Vision changes
  • Swelling in various parts of the body
  • Auditory and visual hallucinations
  • Changes in cognition (thinking)
  • Mood swings
  • Drowsiness
  • Dizziness
  • Headaches
  • Constipation or diarrhea
  • Appetite and weight changes
  • Hair loss
  • Tinnitus (ringing in the ears)

If that's intimidating to you, we're not surprised — and this isn't even a full list, plus we didn't even reach the part where mood stabilizers are not safe for everyone. If you have kidney, liver, or pancreas issues, for instance, or take medications for diabetes, hypertension, and even depression (antidpressants), a whole new set of dangers opens up. Lithium, concretely, can induce toxicity and lead to seizures, slowed and stopped breathing, a coma, and even death. Those taking it should be carefully monitored. 

Mood stabilizers are, then, serious medications that absolutely shouldn't be prescribed to just anyone without a lot of consideration. That means just that — not that they should be taken off the table completely.

Under the right set of circumstances, mood stabilizers represent something no other medication has achieved for a person; liberation from depression, something that could be life-saving, too.

Discuss the pros, cons, and alternatives with your doctor in great detail before you start on one, however. Make sure you follow dosage and usage instructions exactly, and keep your doctor updated on your side effects.

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