Mood stabilizer

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A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.

Uses[edit]

Used to treat bipolar disorder,[1] mood stabilizers suppress swings between mania and depression. Mood-stabilizing drugs are also used in borderline personality disorder[2] and schizoaffective disorder.

Examples[edit]

The term "mood stabilizer" does not describe a mechanism, but rather an effect. More precise terminology is used to classify these agents.

Drugs commonly classed as mood stabilizers include:

Mineral[edit]

Anticonvulsants[edit]

Many agents described as "mood stabilizers" are also categorized as anticonvulsants. The term "anticonvulsant mood stabilizers" is sometimes used to describe these as a class.[5] Although this group is also defined by effect rather than mechanism, there is at least a preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders.[citation needed]

Antipsychotics[edit]

Other[edit]

Combination therapy[edit]

In routine practice, monotherapy is often not sufficiently effective for acute and/or maintenance therapy and thus most patients are given combination therapies.[13] Combination therapy (atypical antipsychotic with lithium or valproate) shows better efficacy over monotherapy in the manic phase in terms of efficacy and prevention of relapse.[13] However, side effects are more frequent and discontinuation rates due to adverse events are higher with combination therapy than with monotherapy.[13]

Relationship to antidepressants[edit]

Most mood stabilizers are primarily antimanic agents, meaning that they are effective at treating mania and mood cycling and shifting, but are not effective at treating acute depression. The principal exceptions to that rule, because they treat both manic and depressive symptoms, are lamotrigine, lithium carbonate and quetiapine.

Nevertheless, antidepressants are still often prescribed in addition to mood stabilizers during depressive phases. This brings some risks, however, as antidepressants can induce mania, psychosis, and other disturbing problems in people with bipolar disorder—in particular, when taken alone. The risk of antidepressant-induced mania when given to patients concomitantly on antimanic agents is not known for certain but may still exist.[14] The majority of antidepressants appear ineffective in treating bipolar depression.[14]

Antidepressants cause several risks when given to bipolar patients. They are ineffective in treating acute bipolar depression, preventing relapse, and can cause rapid cycling. Studies have been shown that antidepressants have no benefit versus a placebo or other treatment. Antidepressants can also lead to a higher rate of non-lethal suicidal behavior. Relapse can also be related to treatment with antidepressants. This is less likely to occur if a mood stabilizer is combined with an antidepressant, rather than an antidepressant being used alone. Evidence from previous studies shows that rapid cycling is linked to use of antidepressants. Rapid cycling is defined as the presence of four or more mood episodes within a year's time. Evidence suggests that rapid cycling and mixed symptoms have become more common since antidepressant medication has come into widespread use. There is a need for caution when treating bipolar patients with antidepressant medication due to the risks that they pose.[citation needed]

Use of mood stabilizers and anticonvulsants such as lamotrigine, carbamazapine, valproate and others may lead to chronic folate deficiency, potentiating depression.[citation needed] Also, "Folate deficiency may increase the risk of depression and reduce the action of antidepressants."[15] L-methylfolate (also formally known as 5-MTHF or Levofolinic acid), a centrally acting trimonoamine modulator, boosts the synthesis of three CNS neurotransmitters: dopamine, norepinephrine and serotonin. Mood stabilizers and anticonvulsants may interfere with folic acid absorption and L-methylfolate formation. Augmentation with the medical food L-methylfolate may improve antidepressant effects of these medicines, including lithium and antidepressants themselves, by boosting the synthesis of antidepressant neurotransmitters.[citation needed] However, the U.S. National Institutes of Health issued a warning caution about the use of L-methylfolate for patients with bipolar disease. [1]

Mechanism[edit]

Many mood stabilizers are also anticonvulsants. A notable exception being lithium.[citation needed]

The precise mechanism of action of Lithium is still unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. Lithium is known to inhibit the enzyme GSK-3b. This has the effect relieving pressure on the circadian clock - which is thought to be often malfunctioning in people with bipolar disorder - and positively modulates gene transcription of Brain Derived Neurotrophic Factor (BDNF). The resulting increase in neural plasticity may be central to lithium's therapeutic effects. Lithium may also increase the synthesis of serotonin.

All of the anti-convulsants routinely used to treat bipolar disorder are blockers of voltage-gated sodium channels, affecting the brain's glutamate system. For valproic acid, carbamazepine and oxcarbazepine, however, their mood-stabilizing effects may be more related to effects on the GABAergic system. Lamotrigine is known to decrease the patient's cortisol response to stress.

One possible downstream target of several mood stabilizers such as lithium, valproate, and carbamazepine is the arachidonic acid cascade.[16]

See also[edit]

References[edit]

  1. ^ "Texas State - Student Health Center". 
  2. ^ "NIMH and Borderline Personality Disorder". 
  3. ^ Marmol, F. (2008). "Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium". Progress in Neuro-Psychopharmacology and Biological Psychiatry 32 (8): 1761–1771. doi:10.1016/j.pnpbp.2008.08.012. PMID 18789369.  edit
  4. ^ Kozier, B et al. (2008). Fundamentals Of Nursing, Concepts, Process, and Practice. London: Pearson Education. p. 189.
  5. ^ Ichikawa J, Dai J, Meltzer HY (July 2005). "Lithium differs from anticonvulsant mood stabilizers in prefrontal cortical and accumbal dopamine release: role of 5-HT(1A) receptor agonism". Brain Res. 1049 (2): 182–90. doi:10.1016/j.brainres.2005.05.005. PMID 15936730. 
  6. ^ Healy D. 2005 Psychiatric Drugs explained 4th ed. Churchill Liviingstone: London p.110
  7. ^ Ghaemi SN, Berv DA, Klugman J, Rosenquist KJ, Hsu DJ (August 2003). "Oxcarbazepine treatment of bipolar disorder". J Clin Psychiatry 64 (8): 943–5. doi:10.4088/JCP.v64n0813. PMID 12927010. 
  8. ^ Vasudev K, Macritchie K, Geddes J, Watson S, Young AH. Topiramate for acute affective episodes in bipolar disorder. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD003384. doi:10.1002/14651858.CD003384.pub2.
  9. ^ By JANE COLLINGWOOD.Emerging Bipolar Therapies.http://psychcentral.com/lib/2007/emerging-bipolar-therapies/.
  10. ^ a b Bowden CL (2005). "Atypical antipsychotic augmentation of mood stabilizer therapy in bipolar disorder". J Clin Psychiatry. 66. Suppl 3: 12–9. PMID 15762830. 
  11. ^ Mirnikjoo B, Brown SE, Kim HF, Marangell LB, Sweatt JD, Weeber EJ (April 2001). "Protein kinase inhibition by omega-3 fatty acids". J. Biol. Chem. 276 (14): 10888–96. doi:10.1074/jbc.M008150200. PMID 11152679. 
  12. ^ Gao, K.; Calabrese, J. R. (2005). "Newer treatment studies for bipolar depression". Bipolar Disorders 7 (s5): 13–23. doi:10.1111/j.1399-5618.2005.00250.x. PMID 16225556.  edit
  13. ^ a b c Geoffroy, P. A.; Etain, B.; Henry, C.; Bellivier, F. (2012). "Combination Therapy for Manic Phases: A Critical Review of a Common Practice". CNS Neuroscience & Therapeutics 18 (12): 957–964. doi:10.1111/cns.12017. PMID 23095277.  edit
  14. ^ a b Amit BH, Weizman A. Antidepressant Treatment for Acute Bipolar Depression: An Update. Depression Research and Treatment [Internet]. 2012 [cited 2013 Jul 18];2012:1–10. Available from: http://www.hindawi.com/journals/drt/2012/684725/
  15. ^ Stephen M. Stahl, MD, PhD. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent. http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267.
  16. ^ Rao JS, Lee HJ, Rapoport SI, Bazinet RP (June 2008). "Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?". Mol. Psychiatry 13 (6): 585–96. doi:10.1038/mp.2008.31. PMID 18347600.