2011 Volume 2 Pages 12-23
Mood stabilizers have been conventionally defined as drugs possessing efficacy in both acute and maintenance therapy for any polarity of bipolar disorder. Only lithium has been regarded as the gold standard mood stabilizer, fulfilling all of these conditions. Recently, evidence for the comprehensive mood-stabilizing effects of second-generation antipsychotics such as quetiapine and olanzapine has been found, although their safety in long-term use is still of great concern. Antiepileptic drugs do not appear to be ideal mood stabilizers because of selective effectiveness on a particular polarity -- for example, valproate and carbamazepine are predominantly antimanic, and lamotrigine is predominantly antidepressive. However, the mood-stabilizing effects of combinations of these drugs may be equivalent or even superior to that of lithium alone, especially in pathophysiologies less responsive to lithium, such as dysphoric mania, mixed features and rapid cycling.