Mood stabilizers

Mood stabilizers are, in short, medications that are used to treat mood disorders including depression and bipolar disorder, Mood fluctuations marked by cyclical episodes of mania and despair are a hallmark of bipolar illness. During the manic period, the symptoms range from extreme exhilaration and boundless vitality to depressive symptoms of depression characterized by low energy, guilt, melancholy, impaired focus, appetite loss, and disturbed sleep. Bipolar illness is sometimes referred to as having a broad spectrum of symptoms, from mania to sadness so it is called manic depression.
Mood stabilizers are used to treat depression, mixed episodes a condition in which mania and depression coexist, acute mania, and hypomania a weak type of mania. After the acute incident, mood stabilizers are used to stop aberrant mood spikes and depressions from recurring cyclically, reducing residual symptoms, preventing manic or depressed relapse, decreasing the frequency of cycling into the next manic or depressive episode, improving functioning, and lowering the risk of suicide are the five basic objectives of maintenance therapy with a mood stabilizer. 

Lithium 

One of the first mood stabilizers for the treatment of bipolar illness was lithium. Similar to sodium, which is found in table salt sodium chloride, lithium is a simple ion. There are two types of lithium: citrate and carbonate. Lithium carbonate comes as pills and capsules with regulated and immediate release.

Lithium citrate is another liquid form of lithium that is available. Lithium has been shown throughout many decades of clinical experience to be useful in treating mania as well as avoiding relapses o bipolar disorder, mania and depression occur. For a long while, lithium was the most effective mood stabilizer; however, in the treatment of bipolar illness, Depakote divalproex sodium, another mood stabilizer, has subsequently overtaken lithium. The reason for this is because lithium has a number of unpleasant side effects, such as weight gain, nausea, diarrhea, and mental drowsiness. Additionally, when blood levels of lithium above their limited therapeutic range, there is a danger of lithium toxicity. Lithium poisoning may be avoided by closely monitoring blood levels of lithium see the lithium handout for additional details.

 
Using Anticonvulsants to Balance Moods

One of the most important developments in contemporary psychiatry has been the use of anticonvulsants in the treatment of mood disorders. For more than 20 years, Tegretol carbamazepine has been used to treat bipolar illness without a U.S. Food and Drug Administration FDA-approved indication for this use. The FDA has authorized carbamazepine for the treatment of acute manic and mixed episodes related to bipolar illness. valproic acid, divalproex, and The FDA has authorized lamotrigine for the treatment of acute manic episodes and seizures related to bipolar disorder. The main purpose of the other anticonvulsants is to cure epilepsy.

The term “labeled use” refers to the administration of a drug for its authorized uses. However, in clinical practice, doctors often prescribe drugs for unlabeled or “off-label” applications when published case reports, clinical studies, The safety and effectiveness of such medicines are corroborated by their own clinical experiences. Several clinical investigations have shown the efficacy of some anti-epileptic drugs in the treatment of bipolar disorder even if there isn’t an FDA-approved indication for this use.

 
Why an anticonvulsant that effectively manages seizures also effectively treats bipolar illness may be a mystery to some. What is the explanation behind this paradox? Part of the reason anticonvulsants were used in psychiatry was serendipitous. People with certain forms of epilepsy might sometimes have mental symptoms such as mood swings, agitation, and hallucinations. These individuals’ seizures and psychological problems were controlled after they received anticonvulsant therapy with phenytoin. 

These findings inspired research into the potential advantages of using additional anticonvulsants, such as carbamazepine and valproic acid and valproate, in the treatment of mood disorders. Numerous clinical investigations have shown the efficacy of carbamazepine, Lamictal, and Depakote for treating bipolar illness. Why certain anticonvulsants work so well for bipolar illness and seizures is unknown. The anticonvulsants, which have very intricate effects on the central nervous system, could work by reducing “kindling” in the brain regions responsible for the mental illness. What happens with kindling is that happens when certain brain areas are repeatedly stimulated below the threshold, causing them to become more sensitive. This might initiate a series of events that can lead to seizures or manic behavior. By reducing the conductivity of electrical waves, Anticonvulsants work well to treat seizures and bipolar disease because they modulate neurotransmitter activity in unstable brain cells.

Mood stabilizers: The role of second-generation antipsychotics

When treating acute mania, antipsychotics are usually taken in addition to a mood stabilizer like lithium or Depakote. Antipsychotics are useful in quickly lowering manic episodes, particularly in the interim before the mood stabilizer which acts more slowly kicks in. After mania subsides, the psychiatrist would often stop the antipsychotic and use the mood stabilizer by itself to maintain mood stability. When the only first-generation antipsychotics that were accessible were the older ones, such chlorpromazine, fluphenazine, thioridazine, and haloperidol, this was the standard procedure. Back then, it was not recommended to use traditional antipsychotics for an extended period of time since these older medications had a large risk of extrapyramidal symptoms and tardive dyskinesia, which are debilitating movement disorders with a late start may have adverse impacts on mobility and coordination. Furthermore, for many people, the traditional medications may make their depression symptoms worse.

The advent of second-generation antipsychotics altered the previously used short-term antipsychotic treatment paradigm for bipolar disorders. These antipsychotics have less unpleasant side effects and have dramatically decreased the likelihood of extrapyramidal symptoms and tardive dyskinesia often seen with the traditional agents. Moreover, it seems that their range of therapeutic efficacy is greater than that of conventional drugs. They seem to have more benefits than merely lessening manic episodes.

characteristics that stabilize mood and, when administered in maintenance treatment, may help avoid relapse. The FDA has authorized olanzapine, aripiprazole, and quetiapine as second-generation antipsychotics for acute mania and maintenance treatment avoidance of relapse in bipolar disease. Although the others are likewise potent antimanic, it is unclear whether they have the ability to stabilize mood for long-term maintenance treatment. Additionally, the FDA recently approved the use of Abilify and risperidone for the treatment of bipolar illness in children and adolescents aged 10 to 17. Abilify is indicated for both acute and maintenance treatment of bipolar disorder, while Risperdal is only approved for use in acute episodes.