What is a Mood Stabilizer?

That all depends on whom you ask.

In Essential Psychopharmacology: Neuroscientific Basis and Practical Applications Stahl writes that the FDA states there is no such thing as a mood stabilizer. That’s not quite true. Granted, there is no “mood stabilizer” product subcategory (under psychotherapeutic agents) in the PDR, but the old “antimanic” has been replaced with “bipolar agents.” Lamictalis approved to “delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy.” Which is about as close to “mood stabilizer” as you can get. Seroquel is approved to treat bipolar mania, mixed states, and bipolar depression; and that about covers the entire tripolar disorder spectrum,1 unless someone knows of a fourth pole.

If you ask PubMed you’ll get several answers. In What makes a drug a primary mood stabilizer? the answer is mainly along the antimanic definition. In What exactly is a mood stabilizer? the answer is “at least two of antimanic, antidepressant and prophylactic properties.” Using those criteria Celexa and Lexapro are mood stabilizers, as they prevent relapses better than other SSRIs.

I’d prefer a more precise taxonomy of true mood stabilizers – LamictalSeroquellithium, and some others to a lesser extent – vs. antimanics such as Depakote and Risperdal. That would be both confusing to most people, since we’ve all grown up on “mood stabilizer = anticonvulsant” so it’s difficult enough to make people understand AED and “mood stabilizer” are not synonyms, and not entirely correct, as some meds that are primarily antimanics can have antidepressant qualities for some-to-many people.

Practically every type of medication has been thrown at bipolar disorder at one time or another. Way back when bipolar was called “manic-depression” it seemed as if every drug in the PDR was tried. And while various things are still thrown at people for whom nothing else is working, most everyone is prescribed either an antiepileptic drug (AED)/anticonvulsant (AC) or an antipsychotic (AP), usually an atypical antipsychotic (AAP), as their primary medication to control bipolar disorder. Sometimes one is enough, sometimes one is part of a cocktail that includes an antidepressant, sometimes they need one (or more) of each, with or without other types of meds. The majority of people with bipolar disorder need one or two daily meds, and their doctors get it right the first or second time. As long as you don’t want perfection and keep the perspective that the side effects suck so much less than the insanely stupid things you can do when manic, let alone when you feel like shit due to this illness, you probably won’t have to ride the med-go-round too often or for too long.

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