Mood Stabilizing Medications

Abstract As bipolar disorder is a recurrent illness over the lifetime of the patient, a central aspect of its successful treatment is the prevention of new mood episodes rather than simply the stabilization of acute manic or depressive episodes. For decades lithium was the only effective medication available for this purpose. However, not all patients responded to lithium, particularly those with a rapid cycling course of illness (four or more affective episodes per year) or mixed states (meeting criteria for depressive and manic states simultaneously). Over the last 15 years or so, fortunately, many new medications have emerged to greatly expand therapeutic options for our patients. Anticonvulsants such as valproate, carbamazepine, and lamotrigine have all received FDA approvals for treatment of bipolar mood states. This article summarizes the roles that lithium and several anticonvulsants play in the current treatment of mood disorders, with attention to their mechanism of action, indications, dosing, and side effects.