List of mood stabilizers
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Comprehensive List of Mood Stabilizers: Efficacy and Safety
Introduction to Mood Stabilizers
Mood stabilizers are a class of medications primarily used to treat mood disorders, such as bipolar disorder. These medications help to control mood swings, preventing both manic and depressive episodes. Despite their widespread use, the term "mood stabilizer" is not officially recognized by the U.S. Food and Drug Administration (FDA), and there is no universally accepted definition among researchers 1.
Commonly Used Mood Stabilizers
Lithium
Lithium is one of the most well-established mood stabilizers. It has been shown to be effective in treating acute manic episodes, acute depressive episodes, and in the prophylaxis of both mania and depression in bipolar disorder 1. Lithium is often considered a first-line treatment due to its comprehensive efficacy 17.
Valproate
Valproate, also known as divalproex, is another widely used mood stabilizer. It is particularly effective in managing acute manic episodes and has shown moderate efficacy in treating depressive symptoms in bipolar disorder 157. Valproate is often used in combination with other medications, such as lithium, to enhance its effectiveness 36.
Lamotrigine
Lamotrigine is primarily effective in the prophylaxis of depressive episodes in bipolar disorder. It has shown significant efficacy in preventing depressive relapses, making it a valuable option for long-term maintenance therapy 17.
Carbamazepine and Oxcarbazepine
Carbamazepine and its derivative, oxcarbazepine, are anticonvulsants that also serve as mood stabilizers. They are effective in treating manic episodes and have shown some efficacy in managing depressive symptoms 246.
Olanzapine
Olanzapine, an atypical antipsychotic, has demonstrated efficacy in treating acute manic episodes and in the maintenance phase of bipolar disorder. It is often used in combination with other mood stabilizers to enhance its therapeutic effects 167.
Combination Therapies
Anticonvulsants and Lithium
Combining anticonvulsants like valproate with lithium has been found to be both safe and effective. This combination is particularly useful in managing refractory bipolar disorder, where single-drug therapy is insufficient 36.
Antipsychotics and Mood Stabilizers
Second-generation antipsychotics (SGAs) such as aripiprazole, quetiapine, and risperidone are often used in combination with mood stabilizers like lithium or valproate. These combinations have shown significant efficacy in reducing both manic and depressive episodes 68.
Adverse Effects and Management
Mood stabilizers are associated with a range of adverse effects, including cognitive, dermatological, endocrine, gastrointestinal, metabolic, and neurological issues. Most adverse effects are dose-related and can be managed by optimizing the drug dosage. However, some rare adverse effects can be severe and may require discontinuation of the medication 2.
Mood Stabilizers in Special Populations
Children and Adolescents
The efficacy of mood stabilizers in children and adolescents is less well-studied compared to adults. Preliminary data suggest that lithium, carbamazepine, and valproate may be effective in this population, but more research is needed to confirm these findings 4.
Adults with Intellectual Disability
Mood stabilizers like lithium and certain antiepileptic drugs have shown some efficacy in managing behavior problems in adults with intellectual disabilities. However, the evidence is limited and should be interpreted with caution 10.
Conclusion
Mood stabilizers play a crucial role in the management of bipolar disorder and other mood disorders. Lithium, valproate, lamotrigine, carbamazepine, and olanzapine are among the most commonly used agents, each with its own efficacy and safety profile. Combination therapies, particularly those involving anticonvulsants and antipsychotics, offer additional benefits but require careful management to avoid adverse effects. Further research is needed to optimize the use of these medications in special populations, such as children and adults with intellectual disabilities.
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Most relevant research papers on this topic
What is a "mood stabilizer"? An evidence-based response.
Lithium is the first-line agent for treating bipolar disorder when considering all four treatment roles, fulfilling the "two-by-two" definition of a mood stabilizer.
Systematic Review
Highly CitedManagement of Adverse Effects of Mood Stabilizers
Mood stabilizers can cause various adverse effects, most of which can be managed by optimizing drug doses, but rare side effects require immediate discontinuation.
Systematic ReviewMood stabilizer combinations: a review of safety and efficacy.
Mood stabilizer combinations, particularly valproate plus lithium, are safe and effective for treating refractory bipolar disorder.
Systematic ReviewHighly CitedMood stabilizers in children and adolescents.
Lithium, carbamazepine, and valproate may be effective mood stabilizers in children and adolescents, but more studies are needed to confirm their efficacy and rationalize their use.
Systematic ReviewMeta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms.
Mood stabilizers, except divalproic acid, show moderate effects on anger reduction in borderline personality disorder patients, while antidepressants show moderate effects on anger reduction and no effect on depression.
Meta-AnalysisHighly CitedMood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: a systematic review and network meta-analysis of randomized controlled trials
Mood stabilizers and antipsychotics are effective in maintaining bipolar disorder, with lurasidone+LIT/VAL and quetiapine+LIT/VAL showing the best results.
Meta-Analysis
Very Rigorous JournalHighly CitedEffectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: a systematic review of randomized controlled trials.
Mood stabilizers, such as lithium, lamotrigine, olanzapine, and valproate semisodium, effectively prevent relapse in bipolar disorder maintenance treatment, with different profiles of efficacy and tolerability.
Meta-AnalysisHighly CitedCombination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety.
Risperidone combined with a mood stabilizer effectively and safely reduces acute mania symptoms compared to mood stabilizers alone.
RCTHighly CitedWeight gain and metabolic effects of mood stabilizers and antipsychotics in pediatric bipolar disorder: a systematic review and pooled analysis of short-term trials.
Combining antipsychotics with mood stabilizers in pediatric bipolar disorder leads to greater weight gain than treatment with one or two mood stabilizers.
Systematic ReviewHighly CitedThe effectiveness of mood stabilizers and antiepileptic medication for the management of behaviour problems in adults with intellectual disability: a systematic review.
Lithium and some antiepileptic mood stabilizer medications show some support for managing behavior problems in adults with intellectual disability, but more rigorous research is needed.
Systematic Review