What is a Mood Stabilizer?

(updated 12/2014)

Overview

The term “mood stabilizer” is used rather loosely sometimes. Some experts have included in their definition the ability to prevent recurrence as well as treat current symptoms. This makes a lot of sense: why not start with the medications that have evidence for keeping you well, in addition to getting you well? But the studies it takes to get such evidence are extremely costly to set up, and thus there are few such reports — only for the really well-funded medications, basically: olanzapine and lamotrigine (and lithium, because it was included in a lamotrigine study). Relying on this definition excludes too many medications that have been very useful, in my experience.

As a recent review pointed out, using combinations of medications to sum their strengths is now the norm, not the exception, in the treatment of bipolar disorder.Bauer This way of thinking leads to another definition sometimes used: “mood stabilizers” are a group of medications which can treat both mania and depression; or at minimum, they treat one of the two and rarely cause the other pole to become worse in the process. Thus they can be used together to make up combinations for a particular patient’s symptoms and history. This is the basis for the medications I’ve listed in my “mood stabilizer” table.

Getting precise  (not sure it’s worth it…)

This review tried to use precise rules for “evidence” for four aspects of treatment, including the ability to:

  1. Treat a person who is currently having manic or hypomanic symptoms (“acute mania”);
  2. Treat a person who is currently having depressive symptoms (“acute depression”);
  3. Prevent recurrence into mania or hypomania; and
  4. Prevent recurrence into depression.

as reflected in the following table:

Mania Depression
Acute Treatment 1 2
Preventive
Treatment
3 4

A simplified version of their result table, using their most practical rules for “evidence”, looks like this:

Mania Depression
Acute Treatment lithium
valproate
olanzapine
verapamil +/-
lithium
Preventive
Treatment
lithium lithium
lamotrigine
(research did not separate preventive effects by relapse direction)

Conclusion

For the moment, rather than get stuck in definitions, I’ve arranged the commonly used medications in a Table of the Main Options, where the pro’s and con’s of each can be viewed using their respective links.