Mood stabilisers in treatment of bipolar disorder

Abstract:

In the last fifty years, a number of medications for the treatment of bipolar disorder have been developed, including mood stabilisers, which are today the main therapy for this psychiatric condition. There is a spectrum of activity across different mood stabilizers, with some being more effective for the treatment of manic episodes and others for the treatment of depressive phase. They also differ in tolerability profiles and potency for drug interactions. Lithium and valproates are effective in treating acute mania and used for maintenance treatment. Carbamazepine is an effective antimanic agent, whereas lamotrigine is effective in preventing depressive episodes of bipolar disorder. Carbamazepine can lower the serum concentration of drugs metabolised by CYP 1A2, 2C9, 2C19 and 3A4 enzymes, as well as its own concentration. Valproates increase the serum concentration of lamotrigine, which may put patients at increased risk of lamotrigine rash. All treatment algorithms for bipolar disorder recommend mood stabilizers as the first-line treatment. However, algorithms are only guidelines, while a thorough knowledge of the properties of each mood stabilizer, clinical experience and clinical assessment are crucial for tailoring an effective treatment to individual patients

Key words:
bipolar disorder, carbamazepine, lamotrigine, lithiumcarbonate, valproic acid