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

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