Lithium is an established treatment for bipolar disorder, and is included in most treatment guidelines because of its availability and its effectiveness.3 Although, compared with its effects on manic symptoms, it seems to be less effective in treating depressive symptoms.4 In practice though, the use of lithium can be complicated by the need for additional psychological and physical assessments.3 Valproate, carbamazepine, and lamotrigine (anticonvulsant medications), are used to treat manic episodes and as long-term mood stabilizers.4,5 The clinical profile of anticonvulsants, however, appears to vary depending on the illness phase (acute versus continuation/ maintenance) and polarity of mood.4 Lamotrigine is effective in preventing depression, rather than mania, and may benefit patients with acute bipolar depression and rapid cycling.6 Carbamazepine and valproate, on the other hand, have proven to be efficacious for maintenance treatment, and the treatment of mania.5,7
References:
1. Malhi GS, Morris G, Hamilton A, et al. The ideal mood stabiliser: a quest for nirvana? Aust N Z J Psychiatry 2017a; 51 (5): 434–435.
2. Chen PH, Tsai SY, Chen PY, et al. Mood stabilizers and risk of all-cause, natural, and suicide mortality in bipolar disorder: a nationwide cohort study. Acta Psychiatr Scand 2023;147(3):234–247.
3. Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord 2017b; 217: 266–280.
4. Manchia M. Extending the specificity of mood stabilizers from clinical response to mortality reduction. Acta Psychiatr Scand 2023; 147 (3): 231–233.
5. Kishi T, Ikuta T, Matsuda Y, et al. Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: a systematic review and network meta-analysis of randomized controlled trials. Mol Psychiatry 2021; 26 (8): 4146–4157.
6. Muzina DJ, Elhaj O, Gajwani P, et al. Lamotrigine and antiepileptic drugs as mood stabilizers in bipolar disorder. Acta Psychiatr Scand 2005; 111 (s426): 21–28.
7. Bowden CL, Singh V. Valproate in bipolar disorder: 2000 onwards. Acta Psychiatr Scand Suppl 2005; 111 (s426): 13–20.