Research & Education

Understanding Mood Stabilizers

Mood disorders are among the most common causes of long-term pharmaceutical use and their increasing prevalence demands our attention. In England, data from the National Health Service Digital indicates that over the past decade, antidepressant use has doubled, evidenced by 70.9 million prescriptions given out in 2018 compared to the 36 million prescriptions noted in 2008. In America, data from the Centers of Disease Control and Prevention (CDC) noted that antidepressant use had increased by 65 percent between the years 1999 and 2014. But depression is only one mood disorder responsible for these staggering statistics. Bipolar disorder and dysthymia also demand prescriptions for mood stabilizing drugs. In addition, many more individuals experience the symptoms of mood disorders such as ongoing feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, guilt, lack of interest, insomnia, decreased energy, and trouble concentrating and yet, they are never officially diagnosed. Some suffer silently, while others turn to “natural” therapies for mood support.

Mood stabilizing drugs remain the most popular answer to mood disorders. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs) are the most frequently prescribed mood stabilizers for depression, while lithium and anticonvulsants are the typical pharmaceuticals given for bipolar disorder. However, all of these agents carry serious side effects that demand watchfulness and caution.

Most synthetic antidepressants function by altering the monoamine transmitter function. For example, SSRIs increase serotonin by preventing its reuptake, while SNRIs prevent the reuptake of both serotonin and norepinephrine. Lithium, a light metal, is an interesting therapy that doesn’t function by altering biochemical pathways and neurotransmitters, but rather, provides mood stability by offering neurotrophic and neuroprotective effects, resulting in enhanced cellular proliferation, differentiation, growth, and regeneration as well as limiting neuronal atrophy or cell death. It has been used for centuries and may be far safer than many synthetic mood stabilizers.

In light of the potential adverse effects of most mood stabilizing pharmaceuticals and the prevalence of mood disorders, there is an increasing interest in herbal and nutraceutical agents as adjunctive or independent therapies for improving mood. According to a systemic review that ought to explore the effect of adjuvant use of nutritional and herbal medicines with mood stabilizing pharmaceuticals, it was found that these therapies have the potential to increase the efficacy of pharmaceutical mood stabilizers, lowering the required therapeutic dose, and therefore, decreasing the potential side effects. Other reviews support the use of various nutritional and herbal agents as sole therapies for supporting and balancing mood.

St. John’s Wort (Hypericum performatum)

St. John’s Wort is the “gold-standard” botanical therapy for depression. Meta-analyses provide ample evidence (27 clinical trials and a total of 3808 patients) of its efficacy for patients with mild-to-moderate depression and state that it functions comparably to traditional SSRIs. A systematic review including 35 studies and 6993 patients compared St. John’s Wort to placebo or traditional antidepressants and found similar efficacy on mild-to-moderate depression and noted that St. John’s Wort had fewer adverse events compared to standard antidepressants. As with most botanical therapies, the mechanism of action is multifaceted. Containing at least 9 compounds with pharmacological actions, St. John’s Wort functions by not only inhibiting MAO-A, an enzyme that catalyzes the oxidative deamination of amines such as dopamine, norepinephrine, and serotonin, but also has affinity for GABA and benzodiazepine receptors. Like traditional antidepressants, its constituents can inhibit monoamine reuptake and mildly decrease inflammatory factors in the brain.

Rhodiola rosea

Rhodiola rosea is another botanical commonly used to stabilize various mood symptoms. In a randomized controlled clinical trial of 80 patients, 400 mg daily of Rhodiola rosea L. or placebo were taken for 14 days. At the end of the trial, significant reduction in self-reported anxiety, stress, anger, confusion, depression, and total mood was noted among the test group. Further, in a phase III clinical trial carried out as a randomized double-blind placebo-controlled study of 89 patients diagnosed with depression according to DSM-IV diagnostic criteria for depression, it was discovered that overall depression, insomnia, emotional instability, and somatization improved significantly with dosages of either 340 or 680 mg daily over a 6-week period.

Other botanicals and nutraceuticals

Systematic reviews and meta-analyses have also been carried out on other botanicals with favorable effects on depression and mood disorders. Two of the most well-studied herbs include saffron (Crocus sativus) and lavender (Lavandula angustifolia). Many nutraceuticals provide a supportive role for mood stability as well as enhancing the effects of mood stabilizing botanicals. The most well-researched nutraceuticals for mood stabilization include omega-3 fatty acids, inositol, probiotics, B-complex vitamins, and zinc.

The need for mood supporting and stabilizing therapies is unquestionable, but the common pharmaceutical solutions, though effective, may carry significant risks. However, various botanicals and nutraceuticals can be used as adjuvants or independent agents for supporting a healthy and well-balanced mood.