What is a good mood stabilizer for a patient with bipolar disorder?

From the Guidelines

Lithium is considered the gold standard treatment for bipolar disorder, and it should be the first-line mood stabilizer due to its strong evidence for preventing both manic and depressive episodes and reducing suicide risk. Several effective mood stabilizers are available for bipolar disorder, including anticonvulsants like valproate (Depakote, 750-1500 mg daily), lamotrigine (Lamictal, 100-200 mg daily), and carbamazepine (Tegretol, 400-1200 mg daily) 1. Second-generation antipsychotics such as quetiapine (Seroquel), olanzapine (Zyprexa), and aripiprazole (Abilify) can function as mood stabilizers as well 1. The best choice depends on the patient's specific symptoms, whether they tend toward mania or depression, their medical history, potential side effects, and pregnancy considerations.

Some key points to consider when choosing a mood stabilizer include:

• The patient's specific symptoms and phase of illness
• Potential side effects and interactions with other medications
• The need for regular blood monitoring to ensure therapeutic levels and prevent toxicity
• The importance of combining medication with psychotherapy and lifestyle modifications for optimal outcomes
• The potential for lifelong treatment, with some individuals needing ongoing therapy to prevent relapse 1

According to the most recent guidelines, lithium or valproate should be used for the maintenance treatment of bipolar disorder, and treatment should continue for at least 2 years after the last episode 1. Regular monitoring of symptoms, side effects, and laboratory tests is essential to ensure the safe and effective use of mood stabilizers 1. By considering these factors and choosing the most appropriate mood stabilizer, patients with bipolar disorder can achieve optimal outcomes and improve their quality of life.

From the FDA Drug Label

Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Lithium is also indicated as a maintenance treatment for individuals with a diagnosis of Bipolar Disorder. Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of those episodes which may occur.

Lithium is a good mood stabilizer for a patient with bipolar disorder. It is indicated for the treatment of manic episodes and as a maintenance treatment to reduce the frequency and intensity of manic episodes 2.

From the Research

Mood Stabilizers for Bipolar Disorder

• Lithium is considered a major mood stabilizer for maintaining long-term stability in patients with bipolar disorder, as evidenced by numerous studies 3, 4, 5.
• The efficacy of lithium as an acute treatment and as a maintenance treatment of bipolar disorder has been demonstrated through modern, randomized, parallel-group designed trials 3.
• Other mood stabilizers, such as valproate and carbamazepine, are also available for the maintenance treatment of patients with bipolar I disorder, but monotherapy with these agents often fails 6.
• Combination therapy, such as lithium plus valproate or lithium plus carbamazepine, may be effective in improving outcome for patients with bipolar disorder 6, 4.
• The potential risks of lithium should be weighed up against its benefits, and serious adverse effects are usually avoidable 3.

Comparison of Mood Stabilizers

• Lithium has more evidence of efficacy than any other agent for prophylaxis of episodes in bipolar disorder 4.
• Carbamazepine and divalproex may be effective in preventing manic episodes, but are less effective in preventing depression 4.
• Lamotrigine has been shown to reduce cycling in patients with bipolar II disorder, and may be effective in preventing depression 4.
• Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy 7.

Mechanisms of Action

• The specific mechanisms by which lithium exerts its mood-stabilizing effects are not well understood, but may involve reduction of excitatory neurotransmission and increase of inhibitory neurotransmission 5.
• Lithium may also have neuroprotective effects, reducing oxidative stress and increasing protective proteins such as brain-derived neurotrophic factor and B-cell lymphoma 2 5.