Section outline

  • Introduction: 

    Mood stabilizers (Thymorégulateurs) are among the core psychotropic medications used to treat mood disorders, primarily Bipolar Disorder. These drugs are known for their ability to regulate and stabilize mood by preventing or reducing the intensity and recurrence of manic or depressive episodes. They are an essential part of a comprehensive treatment plan that includes medication, psychotherapy, family support, and regular follow-up.

    History of Mood Stabilizers: 

    The first mood stabilizer was introduced in 1949, when Australian psychiatrist John Cade discovered the remarkable effects of lithium salt in managing manic episodes in patients with bipolar disorder. Later, other compounds with similar properties were developed, such as anticonvulsants, which proved effective in regulating and stabilizing mood. This expansion was based on both clinical observations and experimental findings, contributing to the development of effective therapeutic protocols for mood disorders.

    Definition of Mood Stabilizers: 

    These are medications that influence electrical activity and neurotransmitter balance in the brain. They regulate imbalances in neurotransmitters such as serotonin, dopamine, norepinephrine, and glutamate. Unlike fast-acting sedatives, mood stabilizers are used for long-term prevention and treatment to reduce relapse and improve patients’ quality of life.

    Types of Mood Stabilizers (In Detail):

    1. Lithium Carbonate:

      • Considered the gold standard in treating bipolar disorder.

      • Mechanism of Action: Believed to inhibit inositol monophosphatase and influence calcium signaling in neurons.

      • Uses: Manic episodes, prevention of manic and depressive episodes, and reduction of suicide risk.

      • Examples: Camcolit, Priadel.

      • Side Effects: Hand tremors, increased thirst and urination, hypothyroidism, impaired kidney function.

      • Monitoring: Requires regular blood tests to monitor lithium levels (0.6–1.2 mEq/L). Overdose can cause toxicity.

      • Important Note: Not recommended during pregnancy due to risk of cardiac malformations in the fetus.

    2. Sodium Valproate:

      • Mechanism of Action: Increases GABA (a major inhibitory neurotransmitter) and reduces neuronal overactivity.

      • Uses: Acute mania, relapse prevention, and aggression-related disorders.

      • Examples: Depakine, Epilim.

      • Side Effects: Gastrointestinal issues, weight gain, hair loss, teratogenicity.

      • Monitoring: Liver function tests, platelet counts, and routine bloodwork.

      • Warning: Contraindicated in pregnant women unless absolutely necessary.

    3. Carbamazepine:

      • Mechanism of Action: Inhibits sodium channels in neurons, reducing excessive neural activity.

      • Uses: Mania, borderline personality disorder, severe aggression, epilepsy.

      • Examples: Tegretol, Carbatrol.

      • Side Effects: Dizziness, nausea, hyponatremia, bone marrow suppression (rare but serious).

      • Monitoring: Blood tests, sodium level monitoring.

    4. Lamotrigine:

      • Mechanism of Action: Inhibits glutamate release and promotes mood stabilization.

      • Uses: Prevention of depressive episodes in bipolar disorder.

      • Examples: Lamictal.

      • Side Effects: Skin rash (can be severe, such as Stevens-Johnson syndrome), headache, dizziness.

      • Note: Dosage should be increased gradually to avoid skin rash.

    5. Oxcarbazepine and Topiramate:

      • Uses: In treatment-resistant mood disorders.

      • Note: Not first-line treatments, but may be used as adjunctive therapy in some cases.

    General Mechanism of Action: Mood stabilizers affect:

    • Chemical Balance: Modulate excessive or deficient neurotransmitter activity.

    • Electrical Activity: Reduce neuronal hyperexcitability to prevent manic episodes.

    • Prevention: Lower the likelihood of mood relapses, whether depressive or manic.

    Clinical Examples:

    • A patient experiencing acute mania is initially treated with a loading dose of valproate, followed by lithium.

    • A female patient with bipolar disorder and frequent depressive episodes is managed with lamotrigine.

    • An individual with borderline personality disorder and emotional dysregulation benefits from a low dose of carbamazepine.

    Precautions:

    • Pregnancy and breastfeeding.

    • Renal and hepatic diseases.

    • Drug interactions (e.g., with diuretics, antipsychotics, antidepressants).

    Role of the Psychologist:

    • Careful observation of mood and behavioral changes.

    • Providing psychoeducation and emotional support regarding medication.

    • Assisting with side-effect management (e.g., anxiety over weight gain).

    • Enhancing treatment adherence.

    Conclusion: 

    Mood stabilizers are not just pharmaceutical tools; they are therapeutic instruments that help restore balance in individuals living with chronic mood disorders. Their success depends on their integration into a holistic treatment approach that includes psychotherapy, medical monitoring, and social support. Awareness and understanding of these medications are essential for psychologists and mental health professionals to accurately assess patient conditions and improve recovery outcomes.

    Some References:

    1. "Lectures in Psychopharmacology" – Prof. Krom Mowafak, 2022.

    2. American Psychiatric Association. (2013). DSM-5.

    3. Stahl, S. M. (2017). Stahl's Essential Psychopharmacology. Cambridge.

    4. Geddes, J. R., & Miklowitz, D. J. (2013). The Lancet, 381(9878), 1672–1682.

    5. Goodwin, G. M. (2016). Evidence-based guidelines for treating bipolar disorder. Journal of Affective Disorders.