Mood Stabilizers for Adolescents: What Parents Should Know

From Behavioral Health Wiki, the evidence-based reference

Understanding Mood Stabilizers

Mood stabilizers are medications that help reduce extreme mood swings and prevent episodes of mania (high energy, impulsive behavior) and severe depression. Unlike other psychiatric medications that primarily target one mood state, mood stabilizers work to keep emotions within a more normal range over time.^[1]

These medications work by affecting brain chemistry in different ways. Some change how nerve cells communicate with each other. Others influence levels of neurotransmitters (brain chemicals that carry messages between cells). The exact mechanisms are still being studied, but research shows these medications can effectively prevent mood episodes when used correctly.^[2]

For adolescents, mood stabilizers are most commonly prescribed for bipolar disorder, but doctors may also use them for other conditions where mood swings are a significant problem. The teenage brain is still developing, which makes both the condition and the treatment more complex than in adults.

Parents often worry about giving their teenager psychiatric medication. This concern is understandable and normal. The key is to understand that untreated mood disorders can have serious consequences for a teen's development, relationships, and future opportunities. When properly prescribed and monitored, mood stabilizers can help adolescents lead healthier, more stable lives.

Lithium: The Gold Standard

Lithium is the oldest and most studied mood stabilizer. It has been used for over 70 years and remains the most effective medication for preventing both manic and depressive episodes in bipolar disorder. Studies show that lithium reduces the risk of suicide in people with bipolar disorder more than any other treatment.^[3]

Lithium is a naturally occurring element, similar to sodium and potassium. In the brain, it appears to protect nerve cells and help them function more normally. It also affects several brain chemicals and may help grow new brain connections. Research suggests lithium can actually help repair some of the brain changes caused by bipolar disorder.^[4]

The FDA has approved lithium for treating manic episodes in people 12 years and older. For younger adolescents, doctors may prescribe it off-label (using an approved medication for a condition not specifically listed on its FDA approval). Clinical studies show lithium works well in teenagers, though they may need different doses than adults.

Lithium requires careful monitoring because the amount in the blood must stay within a specific range to be both safe and effective. Too little, and it won't work. Too much, and it can cause serious side effects. Teenagers typically need blood tests every few months once their dose is stable, and more often when starting treatment or changing doses.

Anticonvulsants as Mood Stabilizers

Several medications originally developed to treat seizures also work as mood stabilizers. The most commonly used anticonvulsants for mood disorders in adolescents include valproate (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol). These medications affect brain chemistry in ways that help prevent mood episodes.^[5]

Valproate is particularly effective for treating manic episodes and preventing future episodes of mania. It works by increasing levels of GABA, a brain chemical that has a calming effect. The FDA has approved valproate for treating manic episodes, though it's not specifically approved for adolescents. Research shows it can be effective in teenagers, but doctors must weigh benefits against potential risks.

Lamotrigine is especially helpful for preventing depressive episodes in bipolar disorder. It works differently from other mood stabilizers by blocking certain brain signals that can trigger mood episodes. One advantage of lamotrigine is that it typically causes less weight gain than other mood stabilizers, which can be important for teenagers concerned about body image.

These medications each have different side effect profiles and monitoring requirements. Some require regular blood tests to check medication levels and liver function. Others need careful dose adjustments to avoid serious but rare side effects. The choice between different anticonvulsants depends on the individual teenager's symptoms, other medical conditions, and response to treatment.

When Doctors Prescribe Mood Stabilizers

Doctors most commonly prescribe mood stabilizers for adolescents diagnosed with bipolar disorder. This condition involves distinct episodes of mania (or hypomania, a milder form) and often depression. During manic episodes, teenagers might have extremely high energy, need very little sleep, make impulsive decisions, or show unusually risky behavior.

The diagnosis process for bipolar disorder in adolescents requires careful evaluation. Normal teenage mood changes can sometimes look like mood disorder symptoms. Experienced child and adolescent psychiatrists use specific criteria and often observe patterns over time before making a diagnosis. They also rule out other conditions that might cause similar symptoms.

Sometimes doctors prescribe mood stabilizers for other conditions where mood instability is a significant problem. This might include severe aggression that doesn't respond to other treatments, or certain types of depression that involve mood swings. These are called "off-label" uses, which means the medication is being used for a condition not specifically approved by the FDA.^[6]

For teenagers with co-occurring disorders (having both a mental health condition and substance use problems), mood stabilizers might be part of a comprehensive treatment plan. Stabilizing mood can sometimes make it easier for adolescents to participate in addiction treatment and maintain recovery.

Side Effects and Monitoring

All mood stabilizers can cause side effects, though not every teenager will experience them. Common side effects vary by medication but may include drowsiness, dizziness, nausea, weight changes, and hand tremors. Most side effects are mild and often improve as the body adjusts to the medication. Serious side effects are less common but require immediate medical attention.^[7]

Weight gain is a particular concern with some mood stabilizers, especially for teenagers who are already sensitive about their appearance. Valproate and lithium can both cause significant weight gain in some people. Doctors and families need to discuss strategies for managing weight, including diet and exercise plans. Some mood stabilizers, like lamotrigine, are less likely to cause weight gain.

Regular monitoring is essential when adolescents take mood stabilizers. This typically includes blood tests to check medication levels, kidney and liver function, and other important markers. For lithium, doctors monitor blood levels, kidney function, and thyroid function. For anticonvulsants, they might check liver enzymes and blood cell counts. The frequency of testing depends on the specific medication and how long the teenager has been taking it.

Parents should watch for signs of serious side effects and know when to contact their doctor immediately. These warning signs might include persistent vomiting, extreme drowsiness, confusion, fever, or unusual bruising or bleeding. Having a clear communication plan with the prescribing doctor helps ensure problems are addressed quickly.

Making Treatment Decisions Together

Deciding whether to start mood stabilizer medication for an adolescent should involve the teenager, parents, and the prescribing doctor working together. This shared decision-making approach helps ensure that everyone understands the potential benefits and risks. Research shows that when families are actively involved in treatment decisions, teenagers are more likely to take their medication as prescribed and have better outcomes.^[8]

The decision-making process should include honest discussions about the teenager's symptoms, how they're affecting daily life, and what other treatments have been tried. Doctors should explain why they're recommending a mood stabilizer, what benefits they expect, and what side effects to watch for. Families should feel comfortable asking questions and expressing concerns.

Many teenagers have strong feelings about taking psychiatric medication. Some worry about being "different" or having their personality changed. Others feel relieved to have treatment that might help them feel more like themselves. Including the teenager in these conversations, while respecting their developmental stage and capacity for understanding, helps build cooperation with treatment.

Treatment planning should also address practical concerns like cost, insurance coverage, and how to manage medication during school hours. Some mood stabilizers need to be taken multiple times per day, which can be challenging during school. Working with school nurses or counselors might help ensure medication compliance without drawing unwanted attention.

Myths and Misconceptions

Many myths surround psychiatric medication for adolescents, and mood stabilizers are no exception. One common misconception is that these medications will change a teenager's personality or make them "zombie-like." In reality, effective mood stabilizer treatment should help teenagers feel more like themselves by reducing the extreme mood swings that interfere with their normal personality and functioning.^[9]

Another myth is that taking mood stabilizers means a teenager will need medication forever. While some adolescents do continue taking mood stabilizers into adulthood, others may eventually be able to reduce or stop their medication under careful medical supervision. The length of treatment depends on the individual's condition, response to treatment, and other factors that change over time.

Some parents worry that mood stabilizers are addictive or that their teenager will become dependent on them. Mood stabilizers are not addictive substances. However, stopping them suddenly can lead to withdrawal symptoms and return of mood symptoms, which is why any changes to medication should always be done under medical supervision with gradual dose adjustments.

There's also a misconception that natural treatments or therapy alone are always better than medication. While therapy is an important part of treatment for mood disorders, and some people do benefit from complementary approaches, severe mood disorders often require medication to prevent serious consequences. The goal is finding the right combination of treatments for each individual teenager.