Mood Stabilizer

Two decades ago, there was 1 drug in the mood stabilizer category: lithium carbonate. Carbamazepine was used in refractory cases and in a small number of specialty clinics. Valproate was entering the scene as a novel and effective mood stabilizer. Since then, it seems that every new anticonvulsant is evaluated for its mood-stabilizing properties. More recently, the atypical antipsychotic drugs have emerged as promising treatments for bipolar disorder, and the evidence supporting their efficacy rivals that of anticonvulsant medications. Other agents, such as calcium-channel blockers, have also been evaluated but have shown little evidence of mood-stabilizing properties. Guidelines for the treatment of bipolar disorder now focus on lithium, a selected number of anticonvulsants and an increasing number of atypical antipsychotic drugs as the principal agents. How does the finding that seemingly disparate classes of medication have a common domain of efficacy shape our definition of what constitutes a “mood stabilizer” and our understanding of their mechanisms of action?...