What do mood stabilizers do
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Understanding the Role and Mechanisms of Mood Stabilizers
Definition and Efficacy of Mood Stabilizers
Mood stabilizers are a class of medications primarily used to treat bipolar disorder, characterized by alternating episodes of mania and depression. 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. However, a proposed definition considers a drug a mood stabilizer if it effectively treats both acute manic and depressive episodes and prevents their recurrence . Lithium is the only medication that consistently meets this definition, showing efficacy in treating acute manic and depressive episodes and in preventing future episodes .
Mechanisms of Action
Cellular Plasticity and Resilience
Mood stabilizers like lithium and valproate target cellular plasticity and resilience pathways. These drugs regulate factors involved in cell survival, such as cyclic adenine monophosphate response element-binding protein, brain-derived neurotrophic factor, and mitogen-activated protein kinases. These pathways are crucial for maintaining cellular health and function, which may be impaired in mood disorders . Lithium, for instance, inhibits enzymes like inositol monophosphatase and glycogen synthase kinase-3 (GSK-3), contributing to its mood-stabilizing effects .
Neuroprotective Properties
Lithium and valproate also exhibit neuroprotective properties. They induce the expression of neurotrophic and neuroprotective proteins, enhance cell survival signaling, and reduce oxidative stress. These actions help protect neurons from damage and support brain health, which is particularly beneficial in treating neurodegenerative and neuropsychiatric disorders . Additionally, these drugs may facilitate anti-inflammation, angiogenesis, and neurogenesis, further contributing to their therapeutic effects .
Clinical Applications and Effectiveness
Bipolar Disorder
Mood stabilizers are most commonly used in the treatment of bipolar disorder. They are effective in managing acute manic episodes and serve as prophylactic agents to prevent future episodes. Lithium, valproate, and carbamazepine are among the most established mood stabilizers for this purpose 29. These medications help reduce the risk of antidepressant-induced manic switches in bipolar I depressed patients, making them a potent strategy for managing this condition .
Borderline Personality Disorder
Mood stabilizers also show efficacy in treating symptoms of borderline personality disorder (BPD), particularly in reducing anger and depression. Meta-analyses indicate that mood stabilizers, except for divalproic acid, have a significant effect on anger reduction in BPD patients. Divalproic acid and carbamazepine also moderately reduce depressive symptoms .
Long-term Maintenance and Tolerability
Mood stabilizers like lithium, lamotrigine, olanzapine, and valproate are effective in the long-term maintenance treatment of bipolar disorder. These medications help prevent relapses of both manic and depressive episodes, although their efficacy and tolerability profiles vary. For instance, lithium and olanzapine are particularly effective in reducing manic relapses, while lamotrigine and valproate are more effective in preventing depressive relapses . However, these medications can have various adverse effects, including cognitive, dermatological, endocrine, gastrointestinal, and neurological issues, which need to be managed carefully .
Conclusion
Mood stabilizers play a crucial role in managing bipolar disorder and other mood-related conditions by stabilizing mood swings and preventing relapses. Lithium remains the gold standard due to its comprehensive efficacy. The mechanisms of action of mood stabilizers involve enhancing cellular plasticity, resilience, and neuroprotection, which are vital for their therapeutic effects. Despite their benefits, the adverse effects of these medications necessitate careful management to ensure patient safety and treatment efficacy.
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