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User:Nurgul Ozkisi/Mood stabilizer

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Mood stabilizers are a class of medications that are primarily used to treat bipolar disorder. They work by stabilizing the mood of individuals with bipolar disorder, which can fluctuate between manic episodes (periods of elevated or irritable mood, increased activity, and reduced need for sleep) and depressive episodes (periods of low mood, loss of interest, and decreased energy).[1] These medications are thought to work by modifying the levels of certain chemicals in the brain, such as serotonin, dopamine, and norepinephrine.[2]

Uses

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Mood stabilizers are a class of psychiatric medications that are primarily used for the treatment of bipolar disorder, a condition characterized by fluctuations in mood between episodes of mania (or hypomania) and depression. These medications work to stabilize mood and prevent the occurrence of manic or depressive episodes. Mood stabilizers are best known for the treatment of bipolar disorder,[3] preventing mood shifts to mania (or hypomania) and depression. Mood stabilizers are also used in schizoaffective disorder when it is the bipolar type.[4]

A very commonly used mood stabilizer is lithium, which has been used for over 50 years in the treatment of bipolar disorder. Lithium has been found to be effective in reducing the frequency and severity of both manic and depressive episodes in patients with bipolar disorder.[5]

Examples

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Although the term "mood stabilizer" has been widely used to describe drugs that can help manage mood swings in various psychiatric conditions, it does not indicate the precise mechanism of action behind these agents. Therefore, to provide more accurate and specific descriptions, pharmacological terminology is used to further classify these drugs based on their mode of action.[6]

there are various classes of drugs that have been identified as mood stabilizers, including but not limited to anticonvulsants, lithium salts, and atypical antipsychotics. These agents have shown effectiveness in managing symptoms of mood disorders, such as bipolar disorder, by modulating the levels of neurotransmitters and other signaling molecules in the brain. [7]

Mineral

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A bottle of lithium capsules that used most commonly for mood stabilizing
  • Lithium – Lithium is the "classic" mood stabilizer, the first to be approved by the US FDA, and still popular in treatment. Therapeutic drug monitoring is required to ensure lithium levels remain in the therapeutic range: 0.6 or 0.8-1.2 mEq/L (or millimolar). Signs and symptoms of toxicity include nausea, vomiting, diarrhea, and ataxia.[8] The most common side effects are lethargy and weight gain. The less common side effects of using lithium are blurred vision, a slight tremble in the hands, and a feeling of being mildly ill. In general, these side effects occur in the first few weeks after commencing lithium treatment. These symptoms can often be improved by lowering the dose.[9]

Anticonvulsants

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Many agents described as "mood stabilizers" are also categorized as anticonvulsants. The term "anticonvulsant mood stabilizers" is sometimes used to describe these as a class.[10] Anticonvulsants like valproic acid, carbamazepine, and lamotrigine have been shown to enhance the activity of inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA), thereby reducing neuronal excitability and preventing mood swings.[11]

  • Valproate – Available in extended release form. This drug can be very irritating to the stomach, especially when taken as a free acid. Liver function and CBC should be monitored.[12]
  • Lamotrigine (aka Lamictal) – FDA approved for bipolar disorder maintenance therapy, not for acute mood problems like depression or mania/hypomania.[13] The usual target dose is 100–200 mg daily, titrated to by 25 mg increments every 2 weeks.[14] Lamotrigine can cause Stevens–Johnson syndrome, a very rare but potentially fatal skin condition.[13]
  • Carbamazepine – FDA approved for the treatment of acute manic or mixed (i.e., both depressed and manic mood features) episodes in people with bipolar disorder type I.[15] Carbamazepine can rarely cause a dangerous decrease in neutrophils, a type of white blood cell, called agranulocytosis.[15] It interacts with many medications, including other mood stabilizers (e.g. lamotrigine) and antipsychotics (e.g. quetiapine).[15]

There is insufficient evidence to support the use of various other anticonvulsants, such as gabapentin and topiramate, as mood stabilizers.[16]

Antipsychotics

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Typical antipsyhotics: Levomepromazin 5mg, flupentixol 5mg and perfenazin 4mg.

Other

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  • It is also conjectured that omega-3 fatty acids may have a mood stabilizing effect.[18] Compared with placebo, omega-3 fatty acids appear better able to augment known mood stabilizers in reducing depressive (but perhaps not manic) symptoms of bipolar disorder; additional trials would be needed to establish the effects of omega-3 fatty acids alone.[19]
  • It is known that even subclinical hypothyroidism can blunt a patient's response to both mood stabilizers and antidepressants. Furthermore, preliminary research into the use of thyroid augmentation in patients with refractory and rapid-cycling bipolar disorder has been positive, showing a slowing in cycle frequency and reduction in symptoms. Most studies have been conducted on an open-label basis. One large, controlled study of 300 mcg daily dose of levothyroxine (T4) found it superior to placebo for this purpose. In general, studies have shown T4 to be well tolerated and to show efficacy even in patients without overt hypothyroidism.[20]


In addition to pharmacological treatments, there are several alternative therapies that have been shown to be effective in managing mood disorders. These therapies can be used alone or in conjunction with medication to improve symptoms and overall quality of life.

Psychotherapy

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Psychotherapy can be a valuable alternative or complement to pharmacological treatments for mood disorders. Several types of therapy have been found to be effective, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). A review of randomized controlled trials found that CBT was effective in reducing symptoms of depression and anxiety in adults. [1]

Exercise

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Exercise has been shown to have mood-stabilizing effects and can be a beneficial addition to treatment for mood disorders. A meta-analysis of randomized controlled trials found that exercise had a moderate to large effect on reducing symptoms of depression. [2]

Relationship to antidepressants

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Most mood stabilizers are primarily antimanic agents, meaning that they are effective at treating mania and mood cycling and shifting, but are not effective at treating acute depression.

Antidepressants are often prescribed alongside mood stabilizers during depressive episodes in individuals with bipolar disorder. However, there are certain risks associated with this combination, as antidepressants can trigger manic or psychotic symptoms, especially if taken alone. It is still unclear whether the risk of antidepressant-induced mania exists when given with antimanic agents. Additionally, research suggests that most antidepressants may not be effective in treating bipolar depression. [3]

Antidepressants cause several risks when given to bipolar patients. They are ineffective in treating acute bipolar depression, preventing relapse, and can cause rapid cycling. Studies have shown that antidepressants have no benefit versus a placebo or other treatment. Antidepressants can also lead to a higher rate of non-lethal suicidal behavior. Relapse can also be related to treatment with antidepressants. This is less likely to occur if a mood stabilizer is combined with an antidepressant, rather than an antidepressant being used alone. Evidence from previous studies shows that rapid cycling is linked to use of antidepressants. Rapid cycling is defined as the presence of four or more mood episodes within a year's time. Evidence suggests that rapid cycling and mixed symptoms have become more common since antidepressant medication has come into widespread use. There is a need for caution when treating bipolar patients with antidepressant medication due to the risks that they pose.[4][5]

Pharmacodynamics

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The precise mechanism of action of lithium is still unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. Lithium is known to inhibit the enzyme GSK-3B. This improves the functioning of the circadian clock—which is thought to be often malfunctioning in people with bipolar disorder—and positively modulates gene transcription of brain-derived neurotrophic factor (BDNF). The resulting increase in neural plasticity may be central to lithium's therapeutic effects. How lithium works in the human body is not completely understood, but its benefits are most likely related to its effects on electrolytes such as potassium, sodium, calcium and magnesium.[21]

All of the anticonvulsants routinely used to treat bipolar disorder are blockers of voltage-gated sodium channels, affecting the brain's glutamate system. For valproic acid, carbamazepine and oxcarbazepine, however, their mood-stabilizing effects may be more related to effects on the GABAergic system. Lamotrigine is known to decrease the patient's cortisol response to stress.[citation needed]

One possible downstream target of several mood stabilizers such as lithium, valproate, and carbamazepine is the arachidonic acid cascade.[22]

References

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  1. ^ Nath, Mala; Gupta, Vikas (2023), "Mood Stabilizers", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32310601, retrieved 2023-03-31
  2. ^ "Mood stabilizer", Wikipedia, 2023-01-18, retrieved 2023-03-31
  3. ^ "Texas State - Student Health Center". Archived from the original on 2008-08-28.
  4. ^ "Schizoaffective disorder - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Mayo Foundation for Medical Education and Research. Retrieved 10 July 2020.
  5. ^ Butler, Andrew C.; Chapman, Jason E.; Forman, Evan M.; Beck, Aaron T. (2006-01). "The empirical status of cognitive-behavioral therapy: a review of meta-analyses". Clinical Psychology Review. 26 (1): 17–31. doi:10.1016/j.cpr.2005.07.003. ISSN 0272-7358. PMID 16199119. {{cite journal}}: Check date values in: |date= (help)
  6. ^ Contributors, WebMD Editorial. "Medication for Bipolar Disorder". WebMD. Retrieved 2023-03-31. {{cite web}}: |last= has generic name (help)
  7. ^ "20158 Mood Stabilizing Medications". CAMH. Retrieved 2023-03-31.
  8. ^ Marmol, F. (2008). "Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 32 (8): 1761–1771. doi:10.1016/j.pnpbp.2008.08.012. PMID 18789369.
  9. ^ Kozier, B et al. (2008). Fundamentals Of Nursing, Concepts, Process, and Practice. London: Pearson Education. p. 189.
  10. ^ Ichikawa J, Dai J, Meltzer HY (July 2005). "Lithium differs from anticonvulsant mood stabilizers in prefrontal cortical and accumbal dopamine release: role of 5-HT(1A) receptor agonism". Brain Res. 1049 (2): 182–90. doi:10.1016/j.brainres.2005.05.005. PMID 15936730.
  11. ^ "How anti-seizure meds can help relieve nerve pain". Mayo Clinic. Retrieved 2023-03-31.
  12. ^ "Depakote 500mg Tablets". electronic Medicine Compendium. Dataphram Communications Limited. Retrieved 28 September 2016.
  13. ^ a b "Lamictal – FDA Prescibing Information".
  14. ^ Healy D. 2005 Psychiatric Drugs explained 4th ed. Churchill Liviingstone: London p.110
  15. ^ a b c "EQUETRO(carbamazepine) Package Insert" (PDF). Validus Pharmaceuticals LLC. Retrieved 10 July 2020.
  16. ^ Terence A. Ketter (3 May 2007). Advances in Treatment of Bipolar Disorder. American Psychiatric Pub. p. 42. ISBN 978-1-58562-666-3.
  17. ^ a b Bowden CL (2005). "Atypical antipsychotic augmentation of mood stabilizer therapy in bipolar disorder". J Clin Psychiatry. 66. Suppl 3: 12–9. PMID 15762830.
  18. ^ Mirnikjoo B, Brown SE, Kim HF, Marangell LB, Sweatt JD, Weeber EJ (April 2001). "Protein kinase inhibition by omega-3 fatty acids". J. Biol. Chem. 276 (14): 10888–96. doi:10.1074/jbc.M008150200. PMID 11152679.
  19. ^ Gao, K.; Calabrese, J. R. (2005). "Newer treatment studies for bipolar depression". Bipolar Disorders. 7 (s5): 13–23. doi:10.1111/j.1399-5618.2005.00250.x. PMID 16225556.
  20. ^ AMA Chakrabarti S. Thyroid Functions and Bipolar Affective Disorder. Journal of Thyroid Research. 2011;2011:306367. doi:10.4061/2011/306367. MLA Chakrabarti, Subho. "Thyroid Functions and Bipolar Affective Disorder". Journal of Thyroid Research 2011 (2011): 306367. PMC. Web. 19 May 2017. APA Chakrabarti, S. (2011). Thyroid Functions and Bipolar Affective Disorder. Journal of Thyroid Research, 2011, 306367. http://doi.org/10.4061/2011/306367
  21. ^ Raber, Jack H. "Lithium carbonate." The Gale Encyclopedia of Mental Disorders, edited by Madeline Harris and Ellen Thackerey, vol. 1, Gale, 2003, pp. 571-573. Gale eBooks, link.gale.com/apps/doc/CX3405700220/GVRL?u=tamp44898&sid=GVRL&xid=9ef84e18. Accessed 20 Jan. 2021.
  22. ^ Rao JS, Lee HJ, Rapoport SI, Bazinet RP (June 2008). "Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?". Mol. Psychiatry. 13 (6): 585–96. doi:10.1038/mp.2008.31. PMID 18347600.
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