A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts.

Contents 1 Uses 2 Relationship to antidepressants 3 Examples 3.1 Anticonvulsants 3.2 Other 4 Mechanism 5 See also 6 References

[edit] Uses

One use is in bipolar disorder,^[1] where mood stabilizers suppress swings between mania and depression.

These drugs are also used in borderline personality disorder.^[2]

[edit] Relationship to antidepressants

Most mood stabilizers are purely antimanic agents, meaning that they are effective at treating mania and mood cycling and shifting, but are not effective at treating depression. The principal exceptions to that rule, because they treat both manic and depressive symptoms, are lamotrigine and lithium carbonate. While an antimanic agent such as valproic acid or carbamazepine cannot treat depression directly as the former two drugs can, it is widely thought to help ward off depression in bipolar patients by keeping them out of mania and thus preventing their moods from cycling.

Nevertheless, an antidepressant is often prescribed in addition to the mood stabilizer during depressive phases. This brings some risks, however, as antidepressants can induce mania, psychosis, and other disturbing problems in bipolar patients -- particularly when taken alone, but sometimes even when used with a mood stabilizer. It should be noted that antidepressants' utility in treating depression-phase bipolar disorder is unclear.

[edit] Examples

The term "mood stabilizer" describes an effect, not a mechanism. More precise terminology is used to classify these agents.

Drugs commonly classed as mood stabilizers include:

[edit] Anticonvulsants

Many agents described as "mood stabilizers" are also categorized as anticonvulsants. The term "anticonvulsant mood stabilizers" is sometimes used to describe these as a class.^[3] Although this group is also defined by effect rather than mechanism, there is at least a preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders.

• Valproic acid (Depakene), divalproex sodium (Depakote), and sodium valproate (Depacon, Epilim) — Available in extended release form. Can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC should be monitored. [Therapeutic drug monitoring is required.]
• Lamotrigine (Lamictal) — Particularly effective for bipolar depression. Monitor for signs and symptoms of Stevens-Johnson syndrome, very rare but can be fatal.
• Carbamazepine (Tegretol) — CBC should be monitored; can lower white blood cell count. Therapeutic drug monitoring is required. Only very recently (as of 2005) FDA-approved for bipolar disorder, but widely used for many years.
• Gabapentin (Neurontin) — Not FDA approved for bipolar disorder. Recent scientific studies suggest it is not an effective treatment, however many psychiatrists continue to use it.
• Oxcarbazepine (Trileptal) — Not FDA approved for bipolar disorder.
• Topiramate (Topamax) — Not FDA approved for bipolar disorder.

[edit] Other

• Lithium carbonate —- Lithium is the 'classic' mood stabilizer. The first mood stabilizer to be approved of the United States Food and Drug Administration, and still popular in treatment. Therapeutic drug monitoring required. Monitor blood lithium levels (therapeutic range: 0.6 or 0.8-1.2 mEq/L) and look for signs and symptoms of toxicity (such as nausea, vomiting, diarrhea, ataxia). See also lithium orotate, another lithium salt.

• Some atypical antipsychotics also have mood stabilizing effects^[4] and are thus commonly prescribed even when psychotic symptoms are absent.^{[citation needed]}

• It is also conjectured that Omega-3 fatty acids may have a mood stabilizing effect.^[5] However, more research is needed to verify this (a multi-year study of this is now being carried out as of 2001).^{[citation needed]}

Sometimes mood stabilizers are used in combination, such as lithium with one of the anticonvulsants.

[edit] Mechanism

Most mood stabilizers are anticonvulsants, with the important exception of lithium, which is the oldest and best known mood stabilizing drug.

One possible downstream target of several mood stabilizers such as lithium, valproate and carbamazepine is arachidonic acid cascade.^[6]

[edit] See also

• ATC code N03
• Treatment of bipolar disorder

[edit] References

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v • d • e Mood disorder: Bipolar disorder History Emil Kraepelin · Karl Leonhard · John Cade · Mogens Schou · Frederick K. Goodwin · Kay Redfield Jamison Symptoms Hallucination · Delusion · Emotional dysregulation (Anhedonia, Dysphoria, Suicidal ideation) · sleep disorder (Hypersomnia, Insomnia) · Psychosis · Racing thoughts Spectrum Bipolar I · Bipolar II · Cyclothymia · Dysthymia · Major depressive disorder · Schizoaffective disorder Mania · Mixed state · Hypomania · Major depressive episode · Rapid cycling Treatment Anticonvulsants Carbamazepine · Gabapentin · Lamotrigine · Oxcarbazepine · Topiramate · Valproic acid (Sodium valproate, Valproate semisodium) Other mood stabilizers Lithium pharmacology (Lithium carbonate, Lithium citrate, Lithium sulfate) · Antipsychotics Non-pharmaceutical Clinical psychology · Electroconvulsive therapy · Involuntary commitment · Light therapy · Psychotherapy · Transcranial magnetic stimulation Related Affective spectrum · List of people affected by bipolar disorder · Bipolar disorder in children

v • d • e Anticonvulsants (N03) GABAA receptor agonist Barbiturates Barbexaclone · Metharbital · Methylphenobarbital · Pentobarbital · Phenobarbital# · Primidone Benzodiazepines Clobazam · Clonazepam · Clorazepate · Diazepam# · Flutoprazepam · Lorazepam · Midazolam · Nimetazepam · Nitrazepam · Temazepam Other GABA agents Aromatic allylic alcohols Stiripentol Carbonic anhydrase inhibitor Sulfa drugs Acetazolamide · Ethoxzolamide · Sultiame · Zonisamide Channel blockers Primarily sodium Hydantoins Ethotoin · Fosphenytoin · Mephenytoin · Phenytoin# Carboxamides Carbamazepine# · Eslicarbazepine acetate · Oxcarbazepine · Rufinamide Primarily calcium Succinimides Ethosuximide# · Mesuximide · Phensuximide Unknown/ungrouped Phenyltriazines Lamotrigine Oxazolidinediones Ethadione · Paramethadione · Trimethadione Ureas Phenacemide · Pheneturide Monosaccharides Topiramate Indirect GABA agents Carboxylic acids/ Fatty acid derivatives GABA transaminase inhibitor: Valproic acid# (Sodium valproate & Valproate semisodium) · Valpromide · Valnoctamide GABA reuptake inhibitor: Tiagabine GABA analogs Gabapentin · Pregabalin · Progabide · Vigabatrin Unknown/multiple/ unsorted Carbamates Emylcamate · Felbamate · Meprobamate · Carisbamate Pyrrolidines Brivaracetam · Levetiracetam · Nefiracetam · Seletracetam Propionates Beclamide · Lacosamide Aldehydes Paraldehyde Bromides Potassium bromide · Sodium bromide #WHO-EM. ‡Withdrawn from market. CLINICAL TRIALS: †Phase III. §Never to phase III