Using mood stabilizer as antidepressant medications
"Mood
stabilizer" has a variety of meanings attached to it. For the lay public,
any medication that helps even one's moods, including the antidepressant
medications, is a mood stabilizer. For most psychiatrists, mood
stabilizer includes a class of medications that treat and prevent mania.
These medications typically include anticonvulsant medications such as
valproic acid and carbamazepine; atypical antipsychotic medications such
as olanzapine, quetiapine, and risperidone; and lithium.
However, the
definition of a true mood stabilizer is a medication that treats and
prevents both depression and mania. No true mood stabilizer by that
definition exists. Perhaps lithium is the closest to meeting that
definition, although it does not truly compare with antidepressants in
effectively treating depression. Other antimanic medications that are
never thought of as mood stabilizers include the antianxiety medications.
At one time, alprazolam was used to treat certain forms of depression as
well as anxiety and mania.
Thus, it is important to understand that when a psychiatrist adds a mood
stabilizer to an antidepressant one needs to know exactly what class of
agent is being prescribed and for what purpose. Many times patients may
have associated symptoms with their depression (such as psychosis), and
therefore, an atypical antipsychotic medication is an appropriate
addition to the antidepressant. Still other patients may experience a
great deal of anxiety and panic, in which case the addition of an
antianxiety agent may be appropriate.
Some patients
may never have had a manic episode, but some of their symptoms and family
history are strongly suggestive of an underlying bipolar disorder. Under
these circumstances, the safest medication to prescribe may be a mood
stabilizer alone, unless the depression is severe enough to warrant
aggressive care, in which case the psychiatrist may prescribe an
antidepressant with an anticonvulsant, lithium, or atypical antipsychotic
as a preventative measure. Finally, some patients may achieve only a
partial response to the antidepressant. When a partial response is
achieved, the psychiatrist will typically add another medication to
augment the primary medication's response rather than switch the
medication altogether.
