Mood stabilizers

Group of drugs principally used for the treatment of bipolar disorders → stabilize the mood → eliminate/reduce acute manic phases/act prophylactically to "stabilize" the mood

Principal mood stabilizers and their MoA
See pharmacology section for more details


 * First-line agent for long-term treatment of mania and its prophylaxis
 * Lithium
 * MoA: Inhibition of the phosphoinositol cascade?, unclear
 * Steady state after 4-5 days (not acute treatment)
 * Besides bipolar disease: also augmentation in the treatment of depression
 * narrow therapeutic range
 * Cave:
 * Drug interactions: NSAIDs, hydrochlorothiazide -> reduce the GFR and can cause increased litihium levels
 * Side effects:
 * Nephrotoxicity (nephrogenic diabetes insipidus
 * Hypothyroidism
 * Teratogenic: can cause Ebstein anomaly (rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn't formed properly. As a result, blood leaks back through the valve and into the right atrium)
 * Acute intoxication: CNS (tremor, confusion), GI upset
 * Valproic acid: In patients with bad renal function (i.e. increased creatinine levels)
 * Others
 * Lamotrigine: especially useful for severe bipolar depression
 * Carbamazepine
 * Antipsychotics: Quetiapine- can be given in combination with lithium or valproic acid in refractory cases