mood stabilisers

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Introduction

‘Mood stabilisers’ is a term used to describe a group of medications, which are used for those with bipolar affective disorder (i.e. those who suffer from episodes of both mania and depression). As the name suggests, they stabilise mood states and some can be used for both prophylaxis and treatment of episodes of depression and mania. The key mood stabilisers include Lithium, Sodium Valproate, Carbamazepine and Lamotrigine. You may recognise some of the mood stabilisers as antiepileptic drugs and this may lead to some confusion if the indication for prescribing is not made clear.

What we already know

Lithium and Sodium Valproate can be used to treat and prevent mania, whereas Carbamazepine has more of a prophylactic role in mania. Lamotrigine is also mood stabiliser, but has better evidence for use in bipolar depression. Some antipsychotics also have mood-stabilising properties, such as Olanzapine or Quetiapine, although these are usually used in combination with a mood stabiliser rather than alone.

Areas of uncertainty

Lithium remains the gold standard in the treatment of bipolar affective disorder and still appears to have the most robust evidence base as a long-term treatment for bipolar disorder, despite the possible side effects on cardiac, renal and thyroid function.

Other mood stabilisers often require use in combination (either with another mood stabiliser, an antipsychotic or an antidepressant, depending on the clinical presentation), but there is limited evidence to suggest which combinations are more appropriate.

There remains uncertainty regarding the precise mechanism of action for mood stabilisers, particularly as medications from very different classes can have mood stabilising effects.

What’s in the pipeline

A 2014 study published in The Lancet showed that rates of violent crime were reduced by 24% in patients with bipolar disorder who were receiving mood stabilisers, although arguably there are other factors which may contribute to this and this may prove useful in future treatments of violence and aggression.

It is important to remember that mood stabilisers are not licensed to treat ‘mood swings’ and this is a very different problem to bipolar affective disorder, although a recent study has explored the prevalence of ‘mood instability’ which further research may distinguish as a separate clinical entity.

References

Taylor D, Paton R, Kapur S. (2015) The Maudsley Prescribing Guidelines in Psychiatry. 12th ed. Chichester: Wiley Blackwell [Publisher]

Semple, D. and Smyth, R. (eds.) (2013) Oxford Handbook of Psychiatry. 3rd ed. Oxford: Oxford University Press [Publisher]

Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. NICE clinical guideline 185, Sep 2014. [Full text]

Medications for Bipolar Disorder. Royal College of Psychiatrists’ Website [Link]

Acknowledgement

Written by: Josephine Neale
Reviewed by:
Last updated: Sep 2015
Review due: Sep 2016

Our mood stabilisers Blogs

Lithium for bipolar disorder: the best maintenance mood stabiliser protection against self-harm and suicide?

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Michael Ostacher provides a robust appraisal of a recent UK cohort study that suggests bipolar disorder patients taking lithium had reduced self-harm and unintentional injury rates, when compared with patients taking valproate, olanzapine or quetiapine.

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Evidence-based guidelines for treating bipolar disorder

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Joseph Hayes summarises the recent British Association for Psychopharmacology guidelines for the treatment of bipolar disorder, and compares their recommendations with those found in the NICE bipolar disorder guidance from 2014.

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Psychotropic medication in pregnancy: new evidence may help achieve a safe balance

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Joanne Wallace considers a recent health technology assessment on the risks and benefits of psychotropic medication in pregnancy, which supports previous associations between valproate and adverse child outcomes.

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Mental illness, challenging behaviour and psychotropic drugs #UCLJournalClub

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Join us at 2-3pm on Wednesday 18th May for the #UCLJournalClub, which will be live broadcasted on YouTube and live tweeted by the @LearningDisElf

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What do you want from your psychiatric medication?

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John Baker presents a systematic review of preferences for medication-associated outcomes in mental disorders, which concludes that we just don’t know what value mental health service users place on the different outcomes that come from taking psychiatric medication.

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Commonly prescribed psychiatric drugs: do they work?

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John Baker summarises a review of commonly prescribed medication that covers seven psychiatric drugs, including antidepressants, antipsychotics, benzodiazepines, amphetamines, methylphenidate and cholinesterase inhibitors.

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What impact are psychotropic drugs having on our physical health?

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John Baker summarises the findings of a recent review of people with schizophrenia, bipolar disorder and depression. The study looks at the adverse effects on physical health of psychotropic drugs (antipsychotics, antidepressants and mood stabilisers).

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Medication for self-harm: new Cochrane review finds very limited evidence to support its use

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Dochka Hristova reports on a new Cochrane review of pharmacological interventions for self-harm in adults, which looks at the treatment effect on repetition of self-harm of antidepressants, antipsychotics, mood stabilisers and dietary supplements.

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Childhood adversity linked to psychotropic drug use in later life

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Andrew Jones summarises a large Finnish population-based cohort study, which finds that childhood adversities strongly predict the use of psychotropic drugs (such as antidepressants and antipsychotics) in adulthood.

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Medication for the maintenance treatment of bipolar disorder

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Elena Marcus summarises a recent network meta-analysis published in The Lancet of the comparative efficacy and tolerability of medication for the maintenance treatment of bipolar disorder.

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