Mood stabilizers

Mood stabilizers

In this chapter, we will define mood stabilizers and will review the various pharmacological mechanisms of action proposed for mood stabilizers. We will also discuss concepts about how to use these drugs in clinical practice, including strategies for what to do if initial treatments fail and how to rationally combine mood stabilizers with another drug. Our treatment of mood stabilizers in this chapter is at the conceptual level, not at the pragmatic level. The reader should consult standard drug handbooks (such as the companion Stahl’s Essential Psychopharmacology: the Prescriber’s

) for details of doses, side effects, drug interactions, and other issues relevant to theGuide prescribing of these drugs in clinical practice.

Definition of a mood stabilizer: a labile label

“There is no such thing as a mood stabilizer” – FDA “Long live the mood stabilizers” – prescribers

What is a mood stabilizer? Originally, a mood stabilizer was a drug that treated mania and prevented recurrence of mania, thus “stabilizing” the manic pole of bipolar disorder. More recently, the concept of mood stabilizer has been defined in a wide-ranging manner, from “something that acts like lithium,” to “an anticonvulsant used to treat bipolar disorder,” to “an atypical antipsychotic used to treat bipolar disorder,” with antidepressants considered as “mood de-stabilizers.” With all this competing terminology, and with the number of drugs for the treatment of bipolar disorder exploding, the term has become so confusing that regulatory authorities and some experts nowmood stabilizer suggest that it is best to use other terms for agents that treat bipolar disorder.

Rather than the term , some would argue that there are drugs that can treat any ormood stabilizers all of four distinct phases of the illness ( and ). Thus, a drug can be “mania-minded”Figures 8-1 8-2 and “treat from above” to reduce symptoms of mania, and/or “stabilize from above” to prevent relapse and recurrence of mania ( ). Furthermore, drugs can be “depression-minded” andFigure 8-1 “treat from

Figure 8-1. . Although the ideal “mood stabilizer” would treat both mania and bipolarMania-minded treatments depression while also preventing episodes of either pole, in reality there is as yet no evidence to suggest that any single agent can achieve this consistently. Rather, different agents may be efficacious for different phases of bipolar disorder. As shown here, some agents seem to be “mania-minded” and thus able to “treat from above” and/or “stabilize from above” – in other words, to reduce and/or prevent symptoms of mania.

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Figure 8-2. . Although the ideal “mood stabilizer” would treat both mania andDepression-minded treatments bipolar depression while also preventing episodes of either pole, as mentioned for , in reality there isFigure 8-1 as yet no evidence to suggest that any single agent can achieve this consistently. Rather, different agents may be efficacious for different phases of bipolar disorder. As shown here, some agents seem to be “depression-minded” and thus able to “treat from below” and/or “stabilize from below” – in other words, to reduce and/or prevent symptoms of bipolar depression.

below” to reduce symptoms of bipolar depression, and/or “stabilize from below” to prevent relapse and recurrence of depression ( ). Not all drugs proven to work in bipolar disorder have allFigure 8-2 four therapeutic actions. In this chapter, we will discuss agents that have one or more of these actions in bipolar disorder, and for historical purposes and simplification, refer to any of these agents as “mood stabilizers.”

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