Editing Mood stabilizer (section)

==Examples==
The term "mood stabilizer" does not describe a mechanism, but rather an effect. More precise terminology based on pharmacology is used to further classify these agents. Drugs commonly classed as mood stabilizers include:

===Mineral===
; [[Lithium (medication)|Lithium]]
: Lithium is the "classic" mood stabilizer, the first to be approved by the US FDA, and still popular in treatment. [[Therapeutic drug monitoring]] is required to ensure lithium levels remain in the therapeutic range: 0.6 to 0.8 or 0.8&ndash;1.2 [[Equivalent (chemistry)|mEq]]/L (or millimolar). Signs and symptoms of toxicity include nausea, vomiting, diarrhea, and [[ataxia]].<ref name=pmid_18789369>{{Cite journal | last1 = Marmol | first1 = F. | title = Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium | doi = 10.1016/j.pnpbp.2008.08.012 | journal = Progress in Neuro-Psychopharmacology and Biological Psychiatry | volume = 32 | issue = 8 | pages = 1761–1771 | year = 2008 | pmid = 18789369 | s2cid = 25861243 }}</ref> The most common side effects are lethargy and weight gain (up to {{convert|2|kg|lb}}).<ref name="Malhi_2013b">{{cite journal |title=Safe and effective use of lithium |journal=Australian Prescriber |volume=36 |pages=18–21 |doi=10.18773/austprescr.2013.008 |year=2013 | vauthors = Malhi GS, Tanious M, Bargh D, Das P, Berk M |doi-access=free}}</ref> The less common side effects of using lithium are blurred vision, a slight tremble in the hands, and a feeling of being mildly ill. In general, these side effects occur in the first few weeks after commencing lithium treatment. These symptoms can often be improved by lowering the dose.<ref>Kozier, B et al. (2008). Fundamentals Of Nursing, Concepts, Process, and Practice. London: Pearson Education. p. 189.</ref>

===Anticonvulsants===
Many agents described as "mood stabilizers" are also categorized as [[anticonvulsants]]. The term "anticonvulsant mood stabilizers" is sometimes used to describe these as a class.<ref name=pmid15936730>{{cite journal |vauthors=Ichikawa J, Dai J, Meltzer HY |title=Lithium differs from anticonvulsant mood stabilizers in prefrontal cortical and accumbal dopamine release: role of 5-HT(1A) receptor agonism |journal=Brain Res. |volume=1049 |issue=2 |pages=182–90 |date=July 2005 |pmid=15936730 |doi=10.1016/j.brainres.2005.05.005 |s2cid=6180568 }}</ref> Although this group is also defined by effect rather than mechanism, there is at least a preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders.{{citation needed|date=March 2013}}

; [[Valproate]]
: Available in extended release form. This drug can be very irritating to the stomach, especially when taken as a free acid. [[Liver function tests|Liver function]] and [[Full blood count|CBC]] should be monitored. Common side effects include sleepiness, nausea, dry mouth. More serious side effects include liver dysfunction, pancreatitis and [[polycystic ovary syndrome]].<ref name="eMC">{{cite web|title=Depakote 500mg Tablets|url=https://www.medicines.org.uk/emc/medicine/25947|website=electronic Medicine Compendium|publisher=Dataphram Communications Limited|access-date=28 September 2016}}</ref><ref name="Depakote FDA label">{{cite web|title=Depakote- divalproex sodium tablet, delayed release|url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08a65cf4-7749-4ceb-6895-8f4805e2b01f |access-date=10 November 2015|url-status=live|archive-url=https://web.archive.org/web/20160305202922/http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08a65cf4-7749-4ceb-6895-8f4805e2b01f|archive-date=5 March 2016}}</ref> Weight gain is possible.<ref>{{cite journal | vauthors = Chukwu J, Delanty N, Webb D, Cavalleri GL | title = Weight change, genetics and antiepileptic drugs | journal = Expert Review of Clinical Pharmacology | volume = 7 | issue = 1 | pages = 43–51 | date = January 2014 | pmid = 24308788 | doi = 10.1586/17512433.2014.857599 | s2cid = 33444886 }}</ref>
; [[Lamotrigine]] (aka Lamictal)
: FDA approved for bipolar disorder maintenance therapy, not for acute mood problems like depression or mania/hypomania.<ref name="FDA Prescribing Information at drugs.com" /> The usual target dose is 100–200&nbsp;mg daily, titrated to by 25&nbsp;mg increments every 2 weeks.<ref>Healy D. 2005 Psychiatric Drugs explained 4th ed. Churchill Liviingstone: London p.110</ref> Lamotrigine can cause [[Stevens–Johnson syndrome]], a very rare but potentially fatal skin condition.<ref name="FDA Prescribing Information at drugs.com">{{cite web | url = https://www.drugs.com/pro/lamictal.html | title = Lamictal – FDA Prescibing Information}}</ref>
; [[Carbamazepine]]
: FDA approved for the treatment of acute manic or mixed (i.e., both depressed and manic mood features) episodes in people with bipolar disorder type I.<ref name="CBZ PI">{{cite web |title=EQUETRO(carbamazepine) Package Insert |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021710s11s012lbl.pdf |archive-url=https://web.archive.org/web/20170217043753/http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021710s11s012lbl.pdf |url-status=dead |archive-date=February 17, 2017 |publisher=Validus Pharmaceuticals LLC|access-date=10 July 2020}}</ref> Carbamazepine can rarely cause a dangerous decrease in [[neutrophils]], a type of [[white blood cell]], called [[agranulocytosis]].<ref name="CBZ PI" /> It [[drug interaction|interacts]] with many medications, including other mood stabilizers (e.g. lamotrigine) and antipsychotics (e.g. [[quetiapine]]).<ref name="CBZ PI" /> It is considered second-line for bipolar disorder due to its side effects.<ref>{{cite journal | vauthors = Nevitt SJ, Marson AG, Weston J, Tudur Smith C | title = Sodium valproate versus phenytoin monotherapy for epilepsy: an individual participant data review | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD001769 | date = August 2018 | issue = 8 | pmid = 30091458 | pmc = 6513104 | doi = 10.1002/14651858.CD001769.pub4 }}</ref>

There is insufficient evidence to support the use of various other anticonvulsants, such as [[gabapentin]] and [[topiramate]], as mood stabilizers.<ref name="Ketter2007">{{cite book | author = Terence A. Ketter | title = Advances in Treatment of Bipolar Disorder | url = https://books.google.com/books?id=aSh-GEQfbhAC&pg=PA42 | date = 3 May 2007 | publisher = American Psychiatric Pub | isbn = 978-1-58562-666-3 | page = 42}}</ref>

===Antipsychotics===
Some [[atypical antipsychotic]]s ([[aripiprazole]], [[asenapine]], [[cariprazine]], [[lurasidone]], [[olanzapine]], [[paliperidone]], [[quetiapine]], [[risperidone]], and [[ziprasidone]]) also have mood stabilizing effects<ref name=pmid15762830>{{cite journal |author=Bowden CL |title=Atypical antipsychotic augmentation of mood stabilizer therapy in bipolar disorder |journal=J Clin Psychiatry |volume=Suppl 3 |series=66|pages=12–9 |year=2005 |pmid=15762830 |url=http://article.psychiatrist.com/?ContentType=START&ID=10001256}}</ref> and are thus commonly prescribed even when [[psychotic]] symptoms are absent.<ref name=pmid15762830/>

===Other===
; Omega-3 fatty acids
: It is also conjectured that [[omega-3 fatty acid]]s may have a mood stabilizing effect.<ref name=pmid11152679>{{cite journal |vauthors=Mirnikjoo B, Brown SE, Kim HF, Marangell LB, Sweatt JD, Weeber EJ |title=Protein kinase inhibition by omega-3 fatty acids |journal=J. Biol. Chem. |volume=276 |issue=14 |pages=10888–96 |date=April 2001 |pmid=11152679 |doi=10.1074/jbc.M008150200 |doi-access=free }}</ref> Compared with placebo, omega-3 fatty acids appear better able to augment known mood stabilizers in reducing depressive (but perhaps not manic) symptoms of bipolar disorder; additional trials would be needed to establish the effects of omega-3 fatty acids alone.<ref>{{Cite journal | doi = 10.1111/j.1399-5618.2005.00250.x | pmid = 16225556 | title = Newer treatment studies for bipolar depression | year = 2005 | last1 = Gao | first1 = K. | last2 = Calabrese | first2 = J. R. | journal = Bipolar Disorders | volume = 7 | issue = s5 | pages = 13–23 }}</ref>
; Levothyroxine
: It is known that even subclinical [[hypothyroidism]] can blunt a patient's response to both mood stabilizers and antidepressants. Furthermore, preliminary research into the use of thyroid augmentation in patients with refractory and rapid-cycling bipolar disorder has been positive, showing a slowing in cycle frequency and reduction in symptoms. Most studies have been conducted on an open-label basis. One large, controlled study of 300 mcg daily dose of [[Levothyroxine|levothyroxine (T<sub>4</sub>)]] found it superior to placebo for this purpose. In general, studies have shown T4 to be well tolerated and to show efficacy even in patients without overt hypothyroidism.<ref>AMA	
Chakrabarti S. Thyroid Functions and Bipolar Affective Disorder. Journal of Thyroid Research. 2011;2011:306367. doi:10.4061/2011/306367.
MLA	Chakrabarti, Subho. "Thyroid Functions and Bipolar Affective Disorder". Journal of Thyroid Research 2011 (2011): 306367. PMC. Web. 19 May 2017.
APA	Chakrabarti, S. (2011). Thyroid Functions and Bipolar Affective Disorder. Journal of Thyroid Research, 2011, 306367. http://doi.org/10.4061/2011/306367</ref> Hypothyrodism is common among bipolar patients regardless of the mood stabilizer used.<ref>{{cite journal | vauthors = Lambert CG, Mazurie AJ, Lauve NR, Hurwitz NG, Young SS, Obenchain RL, Hengartner NW, Perkins DJ, Tohen M, Kerner B | title = Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort | journal = Bipolar Disorders | volume = 18 | issue = 3 | pages = 247–260 | date = May 2016 | pmid = 27226264 | pmc = 5089566 | doi = 10.1111/bdi.12391 }}</ref>

===Combination therapy===
In routine practice, monotherapy is often not sufficiently effective for acute and/or maintenance therapy and thus most patients are given [[combination therapy|combination therapies]].<ref name=Geoffroy-2012/> Combination therapy (atypical antipsychotic with lithium or valproate) shows better efficacy over monotherapy in the manic phase in terms of efficacy and prevention of relapse.<ref name=Geoffroy-2012/> However, side effects are more frequent and discontinuation rates due to adverse events are higher with combination therapy than with monotherapy.<ref name=Geoffroy-2012>{{Cite journal | last1 = Geoffroy | first1 = P. A. | last2 = Etain | first2 = B. | last3 = Henry | first3 = C. | last4 = Bellivier | first4 = F. | title = Combination Therapy for Manic Phases: A Critical Review of a Common Practice | doi = 10.1111/cns.12017 | journal = CNS Neuroscience & Therapeutics | volume = 18 | issue = 12 | pages = 957–964 | year = 2012 | pmid = 23095277 | pmc = 6493634| url = http://www.hal.inserm.fr/inserm-00786653/document }}</ref>