Which medications in the drug class Mood stabilizers are used in the treatment of Bipolar Disorder?

Updated: May 06, 2018
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Mood stabilizers

Lithium is the drug commonly used for prophylaxis and treatment of manic episodes. A 2012 study suggested that lithium may also have a neuroprotective role. [83] However, this agent is also associated with an increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. The consistent finding of a high prevalence of hyperparathyroidism should prompt physicians to check patient calcium concentrations before and during treatment.

Lithium is not associated with a significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. [87] Lithium therapy may serve to protect and preserve the hippocampal volumes, in contrast to patients with major depression (ie, unipolar), who show diminished hippocampal volumes. [88]

Furthermore, recognizing that patients with bipolar disorder are at risk for suicide, lithium may also have some anti-suicidal action. A report from Lewitka and Bauer suggest that lithium may be an option for patients with affective disorders who are at risk for suicide. However, they caution that lithium is still a medication that requires careful assessment and monitoring. Patient adherence is essential. [43]  Many female patients with bipolar disorder will discontinue their lithium medication when they become pregnant. [118]

Lithium carbonate (Lithobid)

Lithium is considered a first-line agent for long-term prophylaxis in bipolar illness, especially for classic bipolar disorder with euphoric mania. It also can be used to treat acute mania, although it cannot be titrated up to an effective level as quickly as valproate can. Evidence suggests that lithium, unlike any other mood stabilizer, may have a specific antisuicide effect.

Monitoring blood levels is critical with this medication. Serum levels should be determined twice weekly during the acute phase, and until the serum level and clinical condition of the patient has been stabilized.

 


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