Category:Mood stabilizers: Difference between revisions

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[[Lithium]]

The '''mood stabilizers''' are the medicines used to treat bipolar disorder: to bring its episodes of mania and of depression under control, and to keep them from returning. The class is an unusual one, defined less by any shared chemistry or mechanism than by that shared clinical purpose, and its founding member was found very nearly by accident. In the late 1940s the Australian psychiatrist John Cade, working at a repatriation hospital outside Melbourne, was pursuing the idea that mania might be caused by some substance circulating in the body. He injected the urine of manic patients into guinea pigs, and, using a lithium salt merely as a way of dissolving a uric acid compound for the work, noticed that the lithium itself left the animals calm. In 1949 he published a small series in which lithium had produced striking improvement in patients with mania.<ref name="cade">Cade JF. Lithium salts in the treatment of psychotic excitement. ''The Medical Journal of Australia''. 1949 Sep 3;2(10):349–352. PMID: 18142718.</ref>

The finding mattered well beyond the medicine itself. At a time when the serious mental illnesses were met chiefly with electroconvulsive therapy and with lobotomy, lithium was, in effect, the first medicine shown to treat a mental illness, and Cade's 1949 paper is often taken to mark the opening of modern psychopharmacology.<ref name="shorter">Shorter E. The history of lithium therapy. ''Bipolar Disorders''. 2009 Jun;11(Suppl 2):4–9. PMID: 19538681.</ref> Lithium in psychiatry was not, strictly, new, the American physician William Hammond had prescribed it for mania as early as 1871, only for the use to be forgotten, but it was Cade's work that carried it into modern medicine.

What followed was not the rapid success the discovery might seem to promise. Lithium is a simple element, it could not be patented, and it is toxic if not carefully dosed; deaths in the 1940s among people who had used lithium salts as a substitute for table salt had given it a frightening reputation. It was the Danish psychiatrist Mogens Schou who, from a controlled trial in 1954 onward, established lithium's worth, and then showed something more, that it could prevent episodes from returning rather than only treat them once they had come.<ref name="shorter"/> The United States was, strikingly, the fiftieth country to admit lithium to its market, in 1970.

For years lithium stood almost alone. Then, from the 1960s and 1970s, several [[:Category:Anticonvulsants|anticonvulsants]] developed for epilepsy were found to control mania and to hold mood steady over the long term, [[valproic acid]] and [[carbamazepine]] among them, and later [[lamotrigine]], which worked best against the depressive side of the illness. From the 1990s a third group joined: several of the atypical antipsychotics proved effective against mania and, in some cases, in preventing relapse.<ref name="geddes">Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. ''Lancet''. 2013 May 11;381(9878):1672–1682. PMID: 23663953.</ref> The word "mood stabilizer" gathered these three unlike origins, an element, the anticonvulsants, the antipsychotics, under a single purpose. The word itself is recent: it was no part of psychiatry's vocabulary in lithium's early decades and spread only in the 1990s, its rise linked by historians in part to the marketing of valproic acid as an alternative to unpatentable lithium.<ref name="shorter"/> It has never been given a precise, agreed definition, and what should count as a mood stabilizer remains genuinely in dispute.

Lithium remains, for many clinicians, the medicine against which the others are measured. It carries the strongest evidence for preventing relapse in bipolar disorder, and, alone among the mood stabilizers, it is associated with a lower risk of suicide; its use has nonetheless fallen in some countries, a decline often laid to the work of monitoring it and to the pull of newer, patentable medicines.<ref name="shorter"/> How the mood stabilizers work is, even now, not well understood, and because the class is gathered by clinical effect rather than by mechanism, its members share no single mode of action. This category collects the wiki's mood-stabilizer pages and groups them by their three origins.

== Mood stabilizers indexed ==

The medicines used as mood stabilizers come, unusually, from three quite different origins, united only by their use in bipolar disorder.

* '''Lithium''': [[lithium]], the element with which the class began, and still, for many clinicians, the standard against which the rest are measured.

* '''Anticonvulsant mood stabilizers''': [[valproic acid]], [[carbamazepine]], [[oxcarbazepine]], and [[lamotrigine]], medicines first developed for epilepsy and also indexed under [[:Category:Anticonvulsants|Anticonvulsants]]. Valproic acid and carbamazepine act most strongly against mania, lamotrigine against the depressive phase.

* '''Atypical antipsychotics used in bipolar disorder''': [[cariprazine]] and [[lumateperone]] are indexed here; several others, among them olanzapine, quetiapine, aripiprazole, and risperidone, serve as mood stabilizers as well and are indexed under [[:Category:Neuroleptics|Neuroleptics]].

== Notes on scope ==

This category indexes the mood stabilizers: the medicines used to control bipolar disorder and to prevent its episodes from returning. The boundary is unusually soft, because the class is defined by purpose rather than by chemistry, and what should count as a mood stabilizer has never had a settled answer.

Two views run alongside each other. A strict one reserves the name for medicines that act against both mania and depression and prevent both from returning, a standard that few medicines fully meet; a looser one applies it to any medicine used in the long-term management of bipolar disorder. The medicines usually discussed under the term differ widely in what they do: lithium acts against both poles and is the one agent nearly everyone includes; valproic acid and carbamazepine are stronger against mania; lamotrigine is the mirror case; and the atypical antipsychotics are effective antimanic agents whose standing as mood stabilizers, rather than as antipsychotics used in bipolar disorder, is itself debated.

<vote slug="moodstab-which-count" type="multi" options="Lithium; Valproate; Lamotrigine; Quetiapine/Olanzapine; Carbamazepine/Oxcarbazepine">Which medicines should count as mood stabilizers?</vote>

Following the wiki's multi-membership convention, the anticonvulsant mood stabilizers also appear under [[:Category:Anticonvulsants|Anticonvulsants]], and the antipsychotic ones under [[:Category:Neuroleptics|Neuroleptics]].

== About these pages ==

Each mood stabilizer indexed here has its own page, built on the wiki's standard structure for a medicine: a history-first account, then pharmacology, indications, adverse effects, and interactions.

This is one of the wiki's MedCategory class-overview pages. It carries the [[:Category:MedCategory|MedCategory]] and [[:Category:MedCategoryFull|MedCategoryFull]] marker tags; the second suppresses the member list that MediaWiki would otherwise generate automatically, leaving the curated index above as the only one the reader sees. The category sits beneath [[:Category:Medicines|Medicines]] and beneath [[:Category:Pharmaceutical|Pharmaceutical]], the origin category for medicines that came into use through scientific discovery rather than traditional practice; lithium reaches medicine as a pharmaceutical because it is an element, a mineral salt rather than a natural product of any living thing.

== References ==

[[Category:MedCategory]]

[[Category:MedCategoryFull]]

[[Category:Medicines]]

[[Category:Pharmaceutical]]

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