What Is The Best Mood Stabilizer For Depression?

What Is The Best Mood Stabilizer For Depression?

Mood stabilizers are medications that help stabilize or control mood swings and fluctuations from a euphoric state (mania) to a low state (depression). They are commonly used in bipolar patients who experience both mania or hypomania and depression. The commonly used mood stabilizers are lithium, anticonvulsants (valproic acid, carbamazepine, lamotrigine, topiramate) and antipsychotics (quetiapine, risperidone, olanzapine, ariprazole, clozapine, ziprasidone). Calcium channel blockers can also be used for mood stabilization in patients who are intolerant to lithium and anticonvulsants.

Traditionally, antidepressants were used for the treatment of bipolar depression. However, in recent times, its use in the treatment of bipolar depression has become questionable. There are various reasons for this belief, which include that antidepressants act as a trigger for mania in bipolar disorder as well as they are believed to have a mood destabilizing effect and increase the frequency of manic and depressive episodes. Recent studies carried out to measure the effectiveness of antidepressants vs. mood stabilizers in bipolar depression showed no benefit of antidepressants any more than a placebo.

Lithium is the most commonly used mood stabilizer. Although, it is very effective in managing the manic relapses, its prevention of depression replaces is limited. Anticonvulsants have proved to be an effective treatment for the management of bipolar depression. Lamotrigine (Lamictal) has an excellent antidepressant activity in bipolar depression; however, its antidepressant activity is limited for major depressive disorder. In addition to that, it is not a potent drug for manic episodes of bipolar. Valproic acid (Depakote) has proved to be very effective in the treatment of acute depression in bipolar disorder. Although carbamazepine has adverse side-effects and not a preferred option, it has been effective in treating bipolar depression and helps in stabilizing mood disorder.

Antipsychotics are an emerging class of mood stabilizers that have proved their efficacy in the treatment of acute mania. However, in the recent studies, their effectiveness in the treatment of acute depression in bipolar patients is gaining widespread acceptance. Quetiapine (Seroquel) has an excellent antidepressant effect and is very effective as acute antidepressants in bipolar patients. Olanzapine has also shown promising results as an acute antidepressant for bipolar disorder, both alone (as Zyprexa) and in combination with fluoxetine (as Symbyax).

Both antipsychotics and anticonvulsants have been shown to be effective in the stabilization of mood for depressed patients. However, it is extremely difficult to pin point, which medication is superior to other as each patient is different and every patient will have different experience with each medication. One medication will be more effective in a particular patient with minimal side-effect and that same medication would be ineffective in another patient. So, a healthcare professional has to try different drugs in each patient. No particular drug can be the best option for all the patients.

Depression is a state of mind where one feels low and hopeless. It is a mood disorder where the emotions and feelings are negatively affected. There are feelings of sadness, dejection, loss of interest in activities that were once enjoyable, lack of focus and concentration, sleep disturbances, psychomotor disturbances, lack of appetite or overeating and suicidal thoughts. Depression can be divided into major depressive disorder, persistent depressive disorder, seasonal affective depression, postpartum depression or depression due to medication, substance abuse or alcohol.

Depression can be diagnosed as a single entity or can co-exist with other disorders, such as bipolar disorder, obsessive compulsive disorder or schizoaffective disorder.

Medications For Depression

Most commonly used medications for depression are antidepressants, which include SSRIs (sertraline, citalopram, escitalopram, paroxetine, paroxetine, fluoxetine), SNRIs (duloxetine, venlafaxine, desvenlafaxine), and NDRIs (bupropion). Less commonly used medications are tricyclic antidepressants (amitriptyline, nortriptyline, doxepin, protriptyline) and MAOIs (phenelzine, selegiline, isocarboxazid).

However, when depression co-exists with bipolar or other mental health conditions, the treatment plan is different and other medications known as mood stabilizers can be found helpful in the treatment.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 25, 2019

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