Table 1

Main classes of mood stabiliser (and alternatives to valproate in the treatment of bipolar disorder), mechanisms
of action and side effects (not including foetal or maternal risks). Compiled from various sources [10, 33, 34,
91–100]

Class Medication Proposed mechanism(s) of action Side effects

name
Mineral Lithium Enhances serotonergic neuron activity, Common: GI upset, fine tremor, polyuria,
inhibits pAp-phosphatase enzyme, polydipsia, metallic taste in mouth, ankle
interacts with nitric oxide signalling oedema, weight gain. Chronic: renal toxicity,
activity hypothyroidism.
Anti-epileptics Sodium GABA potentiation, blocks voltage Common: GI upset, hyperammonaemia
valproate gated sodium channels, epigenetically (causing nausea), weight gain, tremor, hair
inhibits histone deacetylase loss with curly regrowth.
In women: polycystic ovarian syndrome,
hyperandrogenism.
Rare: fulminant liver failure.
Lamotrigine GABA potentiation, suppresses Common: tremors, dizziness, tiredness, loss
glutamate release, inhibits serotonin of co-ordination, menstrual disturbance, dry
reuptake mouth, sleep problems.
Carbamazepine Blocks voltage gated sodium channels Common: dizziness, diplopia, drowsiness,
ataxia, nausea, headaches, dry mouth,
oedema, hyponatraemia, erythematous rash,
sexual dysfunction.
Rare: agranulocytosis.
Atypical Risperidone Dopaminergic (D1–5) receptor Common: sexual dysfunction
antipsychotics antagonist, serotonergic (5-HT2A/C) (hyperprolactinaemia).
Olanzapine receptor antagonist Long term: movement disorders (e.g. tardive
dyskinesia, akathisia, parkinsonism),
Quetiapine increased risk of cardiovascular disease.
Rare: neuroleptic malignant syndrome
Aripiprazole Dopaminergic (D2) and serotonergic (5- Common: weight gain, headache, agitation,
HT1A) receptor partial agonist insomnia, gastrointestinal effects,
disinhibition.