Chapter 13
Mood Stabilizers
- Definition of a mood stabilizer: a labile label
- Lithium: the classic mood stabilizer
- Anticonvulsants as mood stabilizers
- Valproic acid
- Carbamazepine
- Oxcarbazepine/eslicarbazepine
- Lamotrigine
- Riluzole
- Topiramate
- Zonisamide
- Gabapentin and pregabalin
- Levetiracetam
- Atypical antipsychotics: not just for psychotic mania
- Putative pharmacological mechanism of action of atypical antipsychotics in mania and bipolar depression
- Other agents used in bipolar disorder
- Benzodiazepines
- Memantine
- Amantadine
- Ketamine
- Calcium channel blockers (L-type)
- Omega-3 fatty acids
- Inositol
- L-methylfolate (6-(S)-5-methyl-tetrahydrofolate, or MTHF)
- Thyroid hormone
- Do antidepressants make you bipolar?
- Mood stabilizers in clinical practice
- How does one choose a mood stabilizer?
- Symptom-based treatment algorithm for sequential treatment choices and drug combinations in bipolar disorder
- Residual symptoms and circuits after first-line treatment of bipolar disorder
- Bipolar disorder and women
- Children, bipolar disorder, and mood stabilizers
- Combinations of mood stabilizers are the standard for treating bipolar disorder
- Future mood stabilizers
- Summary
Mood Stabilizers
This chapter reviews pharmacological concepts underlying the use of mood stabilizers. There are many definitions of a mood stabilizer and various drugs that act by distinctive mechanisms. The goal of this chapter is to acquaint the reader with current ideas about how different mood stabilizers work. The mechanisms of action of these drugs will be explained by building on general pharmacological concepts introduced in earlier chapters. Also to be discussed are concepts about how these drugs are best used in clinical practice, including strategies for what to do if initial treatments fail and how to rationally combine one mood stabilizer with another, as well as whether and when to combine a mood stabilizer with an antidepressant. Finally, the reader is introduced to some novel mood stabilizers in clinical development that may become available in the future.
The 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 Essential Psychopharmacology: Prescriber’s Guide) for details of doses, side effects, drug interactions, and other issues relevant to the prescribing of these drugs in clinical practice.