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Related Experiment Videos

What is a "mood stabilizer"? An evidence-based response.

Mark S Bauer1, Landis Mitchner

  • 1Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. Mark_Bauer@brown.edu

The American Journal of Psychiatry
|January 2, 2004
PubMed
Summary

Lithium is the only medication that meets a proposed definition for mood stabilizers, demonstrating efficacy in treating and preventing both manic and depressive symptoms in bipolar disorder. This comprehensive review supports lithium as a first-line treatment option.

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Area of Science:

  • Psychiatry and Pharmacology
  • Evidence-Based Medicine

Background:

  • The term "mood stabilizer" lacks an official U.S. Food and Drug Administration (FDA) definition.
  • There is no universally accepted definition of mood stabilizers among researchers.
  • Existing treatments for bipolar disorder vary in their efficacy across different symptom presentations and phases.

Purpose of the Study:

  • To propose and apply a rigorous "two-by-two" definition for mood stabilizers.
  • To systematically review the literature for agents demonstrating efficacy in treating acute manic and depressive symptoms and in prophylaxis of these symptoms in bipolar disorder.
  • To identify which, if any, agents meet the proposed definition of a mood stabilizer.

Main Methods:

  • Conducted a comprehensive literature review of U.S. Agency for Healthcare Research and Quality class A controlled trials.

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  • Classified trials as positive or negative based on primary outcomes.
  • Applied an "FDA-like" criterion requiring at least two positive placebo-controlled trials for efficacy.
  • Performed sensitivity analyses by adjusting trial inclusion criteria.

    • Main Results:

    • Identified 111 relevant trials from 551 candidate articles.
    • Lithium demonstrated efficacy in acute mania, acute depression, and prophylaxis of both mania and depression.
    • Valproate and olanzapine showed efficacy in acute mania; lamotrigine in prophylaxis.
    • Only lithium met the proposed "two-by-two" definition of a mood stabilizer.

    Conclusions:

    • Lithium is the only agent that fulfills the proposed definition of a mood stabilizer when considering all four treatment roles.
    • Evidence supports lithium as a first-line agent for bipolar disorder treatment.
    • The study highlights unmet needs and provides a framework for evaluating future bipolar disorder treatments.