Friday, January 02, 2004

What Is A Mood Stabilizer? Perhaps it is a little like the parable of "The Emperor's New Clothes" by Hans Christian Anderson but in Psychiatry we have been using the term "mood stabilizer" for many years and there has been no formal definition. According to an article in the January 2004 Americal Journal of Psychiatry, "the term "mood stabilizer" is widely used in the context of treating bipolar disorder, but the U.S. Food and Drug Administration (FDA) does not officially recognize the term, and no consensus definition is accepted among investigators." It is proposed that a formal definition of a mood stabilizer should be established and include two aspects: 1) efficacy in treating acute manic and depressive symptoms and 2) prophylaxis of manic and depressive symptoms in bipolar disorder. The authors of the article conducted a review of the literature to evaluate the efficacy of agents to determine which if any agents meet this definition of mood stabilizer. Interestingly, the first (1994) American Psychiatric Association's Practice Guideline for Treatment of Patients With Bipolar Disorder defines mood stabilizers as "medications with both antimanic and antidepressive actions" and the second edition (2002) makes no attempt at a definition but rather asks the question, "is there a more clinically and scientifically useful definition of a "mood stabilizer"? Do newer agents (e.g., atypical antipsychotics and anticonvulsants) have true "mood-stabilizing" properties?" So the newer guideline leaves the question open for study and asks for a definition. The AJP study takes up this charge and attempts to evaluate such a definition from empirical evidence. The authors identified 551 candidate articles, yielding 111 class A trials, including 81 monotherapy trials with 95 independent analyses published through June 2002. Lithium, valproate, and olanzapine had unequivocal evidence for efficacy in acute manic episodes, lithium in acute depressive episodes and in prophylaxis of mania and depression, and lamotrigine in prophylaxis. However, only lithium fulfilled the a priori definition of a mood stabilizer. Relaxing the quality criterion did not change this finding, while raising the threshold resulted in no agents fulfilling the definition. The analysis highlights the need for continued research and a coordinated effort in establishing a formal definition of mood stabilizer. Am J Psychiatry 161:3-18, January 2004 10:54:24 PM    comment []

© Copyright 2004 rsk. Last update: 2/18/04; 11:55:50 PM.