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What Exactly is a “Mood Stabilizer?”

A mental health professional recently referred a patient to the medical clinic “for consideration of a mood stabilizer.”  I had to call him back to ask what he meant.

“Mood Stabilizer” can mean many different things to different people.  Here are some of the definitions of “Mood Stabilizer” that I have heard over the years:

  1. Lithium only.  One psychiatrist I know insists “There is only one mood stabilizer and that is Lithium!”  He says this is because historically, lithium was the first drug ever referred to in the literature and marketed as a “Mood Stabilizer,” and, in this psychiatrist’s opinion, it is still the only drug on the market that can be used to treat both bipolar mania and bipolar depression.  Therefore, it is the only true mood stabilizer.
  2. Lithium plus Lamictal only.  A second psychiatrist I once talked to agreed that a true “mood stabilizer” must treat both bipolar mania and bipolar depression, but he maintained that Lamictal had this property as well as lithium.  So for this psychiatrist, there are two mood stabilizers, Lamictal and lithium.
  3. Lithium plus all of the anti-convulsants used to treat bipolar disorder.  If you look up “mood stabilizer” in many psychiatric textbooks or websites such as Uptodate or Prescriber’s Letter, it is clear that these sources consider the term “mood stabilizer” to include lithium plus all of the anticonvulsants used in psychiatry, such as Depakote , Tegretal , Lamictal.  Many sources even include as “mood stabilizers” anticonvulsants that aren’t used much as psychiatric drugs, such as Trileptal and Topamax.
  4. Any drug used to treat Bipolar disorder.  This group would include Lithium and the anticonvulsants such as Lamictal, Depakote, and Tegetol, but would also add the atypical antipsychotics, such as Seroquel, Abilify, Risperdal, etc.  Some (but not all) would include all antipsychotics, such as Haldol and Thorazine.
  5. All psychiatric drugs.  My psychiatrist mentor believes that all psychiatric drugs should be considered “mood stabilizers” because they all bring abnormal moods back towards the mean, thereby stabilizing them.  So antidepressants should be considered to be “mood stabilizers” as well as bipolar drugs.  Ditto anti-anxiety drugs.  You could probably expand this to include any medication that makes you feel better.  A patient once even told me that marijuana was a mood stabilizer!  This is the kind of thinking that underlies the “self-medicating” phenomenon, as in “I use crystal meth because I am self-medicating my ADHD.”  If this is true, then any drug, legal or illegal, that makes you feel better could be considered to be a “mood stabilizer.”
  6. Mood stabilizer” is a garbage term.  Finally, I have spoken to psychiatrists who believe that the term “mood stabilizer” means so many things to so many different people that it has lost its meaning entirely.  It is a garbage term that means nothing.  Some psychiatric sources don’t use the term any more. One example is The Medical Letter.
I am kind of leaning this way myself.  When I called the mental health professional who had referred the patient “for consideration of a mood stabilizer” to ask him what he meant, he wondered if a small dose of risperidone would help a patient calm down a little.  Who would have predicted that?

What does “mood stabilizer” mean to you?

For that matter, if a patient is described as having “mood instability,” what does that mean?

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One thought on “What Exactly is a “Mood Stabilizer?”

  1. Dean Kartweil MD

    A mood stabilizer is a substance that ”PREVENTS” future episodes in either pole — ie, mania or depression. Look on pubmed for recent articles by Fredrick Goodwin MD, (co-wrote standard medical text in psychiatry, “Manic Depressive Illness.” Accordingly you’re right, lithium and lamotrigine (lamictal) are great.

    However, in the prison population, you might want stronger and faster effects. In that case, the bigger guns (antipsychotics may be useful).

    Also look at psycheducation.org by Jim Phelps, MD.

    Reply

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