Skip to main content
SpringerLink
Log in

Mood Stabilizers: Classification, Indications and Differential Indications

  • Living reference work entry
  • First Online:
NeuroPsychopharmacotherapy

  • 241 Accesses

Abstract

Pharmacological long-term maintenance treatment of bipolar disorder usually consists of mood stabilizing agents. While there is no consensus on the exact definition of mood stabilizer, it is widely accepted that a mood stabilizing agent should have at least two of the four properties: anti-manic, anti-depressant, preventing relapse of depression, and preventing relapse of mania. Thus, mood stabilizing agents belong to a heterogeneous class of drugs acting through many different mechanisms. Lithium still remains the gold standard in the maintenance treatment of bipolar disorder. In addition, anticonvulsants such as valproate and lamotrigine and atypical antipsychotics such as quetiapine, olanzapine, aripiprazole, and risperidone exert mood stabilizing properties. In addition, mood stabilizers may be also used for several differential indications, such as treatment-resistant unipolar depression, schizoaffective disorder, and borderline personality disorder. This chapter is meant to give an overview; the detailed mechanisms of the several drugs and the indications/differential indications are discussed in the respective chapters.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Alda M. Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Mol Psychiatry. 2015;20:661–70.

    Article  CAS  Google Scholar 

  • Angst J, Gamma A, Sellaro R, Lavori PW, Zhang H. Recurrence of bipolar disorders and major depression. A life-long perspective. Eur Arch Psychiatry Clin Neurosci. 2003;253:236–40.

    Article  Google Scholar 

  • Baldessarini RJ, Undurraga J, Vazquez GH, Tondo L, Salvatore P, Ha K, Khalsa HM, Lepri B, Ha TH, Chang JS, Tohen M, Vieta E. Predominant recurrence polarity among 928 adult international bipolar I disorder patients. Acta Psychiatr Scand. 2012;125:293–302.

    Article  CAS  Google Scholar 

  • Baldessarini RJ, Tondo L, Vazquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry. 2018;24:198.

    Article  Google Scholar 

  • Belli H, Ural C, Akbudak M. Borderline personality disorder: bipolarity, mood stabilizers and atypical antipsychotics in treatment. J Clin Med Res. 2012;4:301–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bond DJ, Lam RW, Yatham LN. Divalproex sodium versus placebo in the treatment of acute bipolar depression: a systematic review and meta-analysis. J Affect Disord. 2010;124:228–34.

    Article  CAS  Google Scholar 

  • Canadian Agency for Drugs and Technologies in Health (CADTH). Aripiprazole for borderline personality disorder: a review of the clinical effectiveness. In: Aripiprazole for borderline personality disorder: a review of the clinical effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2017.

    Google Scholar 

  • Carvalho AF, Quevedo J, McIntyre RS, Soeiro-de-Souza MG, Fountoulakis KN, Berk M, Hyphantis TN, Vieta E. Treatment implications of predominant polarity and the polarity index: a comprehensive review. Int J Neuropsychopharmacol. 2014;18(2):1–11.

    Article  Google Scholar 

  • Crawford MJ, Sanatinia R, Barrett B, Cunningham G, Dale O, Ganguli P, Lawrence-Smith G, Leeson V, Lemonsky F, Lykomitrou G, Montgomery AA, Morriss R, Munjiza J, Paton C, Skorodzien I, Singh V, Tan W, Tyrer P, Reilly JG, LABILE Study Team. The clinical effectiveness and cost-effectiveness of lamotrigine in borderline personality disorder: a randomized placebo-controlled trial. Am J Psychiatry. 2018;175:756–64.

    Article  Google Scholar 

  • Crossley NA, Bauer M. Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials. J Clin Psychiatry. 2007;68:935–40.

    Article  CAS  Google Scholar 

  • Fawcett JA. Lithium combinations in acute and maintenance treatment of unipolar and bipolar depression. J Clin Psychiatry. 2003;64(Suppl 5):32–7.

    CAS  PubMed  Google Scholar 

  • Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003;361:653–61.

    Article  CAS  Google Scholar 

  • Geddes JR, Calabrese JR, Goodwin GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry. 2009;194:4–9.

    Article  Google Scholar 

  • Grande I, Balanza-Martinez V, Jimenez-Arriero M, Iglesias Lorenzo FG, Franch Valverde JI, de Arce R, Zaragoza S, Cobaleda S, Vieta E, SIN-DEPRES Group. Clinical factors leading to lamotrigine prescription in bipolar outpatients: subanalysis of the SIN-DEPRES study. J Affect Disord. 2012;143:102–8.

    Article  CAS  Google Scholar 

  • Gunderson JG, Choi-Kain LW. Medication management for patients with borderline personality disorder. Am J Psychiatry. 2018;175:709–11.

    Article  Google Scholar 

  • Guzzetta F, Tondo L, Centorrino F, Baldessarini RJ. Lithium treatment reduces suicide risk in recurrent major depressive disorder. J Clin Psychiatry. 2007;68:380–3.

    Article  Google Scholar 

  • Hansen R, Gaynes B, Thieda P, Gartlehner G, Deveaugh-Geiss A, Krebs E, Lohr K. Meta-analysis of major depressive disorder relapse and recurrence with second-generation antidepressants. Psychiatr Serv. 2008;59:1121–30.

    Article  Google Scholar 

  • Landmark CJ. Targets for antiepileptic drugs in the synapse. Med Sci Monit. 2007;13:RA1–7.

    CAS  PubMed  Google Scholar 

  • Mazza M, Marano G, Traversi G, Carocci V, Romano B, Janiri L. Cariprazine in bipolar depression and mania: state of the art. CNS Neurol Disord Drug Targets. 2018;17:723.

    Article  CAS  Google Scholar 

  • Miura T, Noma H, Furukawa TA, Mitsuyasu H, Tanaka S, Stockton S, Salanti G, Motomura K, Shimano-Katsuki S, Leucht S, Cipriani A, Geddes JR, Kanba S. Comparative efficacy and tolerability of pharmacological treatments in the maintenance treatment of bipolar disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1:351–9.

    Article  Google Scholar 

  • Morsel AM, Morrens M, Sabbe B. An overview of pharmacotherapy for bipolar I disorder. Expert Opin Pharmacother. 2018;19:203–22.

    Article  CAS  Google Scholar 

  • Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009;166:980–91.

    Article  Google Scholar 

  • Nierenberg AA, Husain MM, Trivedi MH, Fava M, Warden D, Wisniewski SR, Miyahara S, Rush AJ. Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR∗D report. Psychol Med. 2010;40:41–50.

    Article  CAS  Google Scholar 

  • Paolini E, Mezzetti FA, Pierri F, Moretti P. Pharmacological treatment of borderline personality disorder: a retrospective observational study at inpatient unit in Italy. Int J Psychiatry Clin Pract. 2017;21:75–9.

    Article  CAS  Google Scholar 

  • Solomon DA, Keller MB, Leon AC, Mueller TI, Lavori PW, Shea MT, Coryell W, Warshaw M, Turvey C, Maser JD, Endicott J. Multiple recurrences of major depressive disorder. Am J Psychiatry. 2000;157:229–33.

    Article  CAS  Google Scholar 

  • Ventriglio A, Vincenti A, Centorrino F, Talamo A, Fitzmaurice G, Baldessarini RJ. Use of mood stabilizers for hospitalized psychotic and bipolar disorder patients. Int Clin Psychopharmacol. 2011;26:88–95.

    Article  Google Scholar 

  • Vieta E. Developing an individualized treatment plan for patients with schizoaffective disorder: from pharmacotherapy to psychoeducation. J Clin Psychiatry. 2010;71(Suppl 2):14–9.

    Article  Google Scholar 

  • Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, Gao K, Miskowiak KW, Grande I. Bipolar disorders. Nat Rev Dis Primers. 2018;4:18008. https://doi.org/10.1038/nrdp.2018.8.

    Article  PubMed  Google Scholar 

  • Vincenzi B, Greene CM, Ulloa M, Parnarouskis L, Jackson JW, Henderson DC. Lithium or valproate adjunctive therapy to second-generation antipsychotics and metabolic variables in patients with schizophrenia or schizoaffective disorder. J Psychiatr Pract. 2016;22:175–82.

    Article  Google Scholar 

  • Weisler RH, Calabrese JR, Thase ME, Arvekvist R, Stening G, Paulsson B, Suppes T. Efficacy of quetiapine monotherapy for the treatment of depressive episodes in bipolar I disorder: a post hoc analysis of combined results from 2 double-blind, randomized, placebo-controlled studies. J Clin Psychiatry. 2008;69:769–82.

    Article  CAS  Google Scholar 

  • Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O’Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20:97–170.

    Article  Google Scholar 

  • Yildiz A, Vieta E, Leucht S, Baldessarini RJ. Efficacy of antimanic treatments: meta-analysis of randomized, controlled trials. Neuropsychopharmacology. 2011;36:375–89.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany

    Andreas Menke

Authors
  1. Andreas Menke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Menke .

Editor information

Editors and Affiliations

  1. Dept Psychiatry , Psychosomatics & Psychotherapy, University of Würzburg, Medical School Clinical Neurochemistry, Würzburg, Germany

    Peter Riederer

  2. Inst für Psychologische Medizin, Haag, Bayern, Germany

    Gerd Laux

  3. Department of Psychiatry, University of Toronto Department of Psychiatry, Toronto, ON, Canada

    Benoit Mulsant

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Fujita Health University School Medicine, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

Section Editor information

  1. Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany

    Andreas Menke

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Menke, A. (2020). Mood Stabilizers: Classification, Indications and Differential Indications. In: Riederer, P., Laux, G., Mulsant, B., Le, W., Nagatsu, T. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_36-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56015-1_36-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56015-1

  • Online ISBN: 978-3-319-56015-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation