What makes a drug a primary mood stabilizer?

Abstract

The term 'mood stabilizer' has been applied to a number of medications for the treatment of patients with bipolar disorder. The operational definition of the properties of a mood-stabilizing medication has varied according to the properties of specific medications and the clinical characteristics of the illness. Randomized controlled trials of agents accepted or proposed as mood stabilizers are reviewed to marshall the available evidence in support of this claim. In addition, potential pharmacological mechanisms underlying mood-stabilizing effects of established compounds are reviewed. Molecular Psychiatry (2002) 7, S8-S14.

The Psychopathology and Treatment of Bipolar Disorder

“…The strictest definition of a mood stabilizer is a medication effective in treating or preventing manic, mixed, or depressive episodes without triggering episodes of the opposite polarity (Keck et al 2002). Currently, the Food and Drug Administration has approved only five medications for BD: lithium, the traditional antipsychotic chlorpromazine (Thorazine), the anticonvulsant divalproex sodium (also known as valproate, and usually marketed as Depakote, Depakene, or Depakon), the atypical antipsychotic olanzapine (Zyprexa), and the anticonvulsant lamotrigine (Lamictal).…”

Towards a Comprehensive Understanding of Bipolar Disorder: In Vivo MRS Investigation of the Phosphatidylinositol Cycle

“…While not entirely abandoned, Kasper (16) makes the point that successful symptom treatment and prevention in bipolar disorder is not easily attainable with the use of only one medication; indicating a need for a "multi-pronged" approach. According to Keck and colleagues (17), this can be explained in terms of a change in the definition of the properties that characterize mood-stabilizing medication as a result of variation in both the properties 1 Lithium was originally discovered by Johann August Arfvedson in 1817, followed in 1880 by its introduction into the field of psychiatry, by John Aulde and Carl Lange, for the prophylactic treatment of depression. Shortly after 1880, cases of lethal lithium toxicity resulted in widespread discontinuation of lithium in medicine; only to be re-introduced following publication of the findings of John Cade in 1949. of specific medications and the clinical characteristics of the illness.…”

Toward Convergence in the Medication Treatment of Bipolar Disorder and Schizophrenia

“…4,68 When response to antipsychotic treatment is inadequate, classic mood stabilizers such as lithium and anticonvulsants have been used among patients with a diagnosis of schizophrenia, with rates of utilization (adjunctive to antipsychotic therapy) approaching 50%. 5 9 This adjunctive use of valproate in schizophrenia is not short term; patients received valproate for an average period of 72% of their entire hospital stays in 1998. 69 It must be emphasized, however, that this use was adjunctive and that monotherapy with a classic mood stabilizer is ineffective in schizophrenia-reflecting a key difference between schizophrenia and bipolar disorder.…”