Byline: Ajit. Avasthi, Sandeep. Grover, Munish. Aggarwal
Mood stabilizers have revolutionized the treatment of bipolar affective disorders. We review data originating from India in the form of efficacy, effectiveness, usefulness, safety and tolerability of mood stabilizers. Data is mainly available for the usefulness and side-effects of lithium. A few studies in recent times have evaluated the usefulness of carbamazepine, valproate, atypical antipsychotics and verapamil. Occasional studies have compared two mood stabilizers. Data for long term efficacy and safety is conspicuously lacking.
Psychopharmacology has revolutionized the understanding and treatment of major mental disorders. With the help of psychopharmacological agents, not only is the neurobiology of various psychiatric disorders being understood, but effective treatments have improved relapse rates, symptom free period, significantly improved the quality of life of patients and have reduced the burden experienced by patients and their families.
Prior to lithium, typical antipsychotics and electroconvulsive therapy was used for management of bipolar disorders. However, over the years many drugs have been evaluated as mood stabilizers and have been shown to be efficacious, although the definition of a mood stabilizer is not yet settled.
Psychopharmacological research in India regarding mood stabilizers has lagged behind the data from the West. However, there has been a shift of research from mere case series to attempts at multicentric double blind controlled trials. In this review, we would review data on mood stabilizers originating from India on various mood stabilizers. The review shall focus on the research published in Indian Journal of Psychiatry and studies reported in PubMed indexed journals.
Amongst various mood stabilizers now available in India, lithium has been the most researched of all. There are a few studies on other mood stabilizers such as carbamazepine and sodium valproate.
After its introduction in India in the late 1960s, lithium aroused a lot of research interest in the 1970s and 80s, with most of the research revolving around open trials to see its usefulness in various disorders (mainly mood disorders) and its side-effect.
Effectiveness in mood disorders
The mood stabilizing property of lithium has led Indian researchers to see its effects in affective disorders. In their earliest work on role of lithium on mood disorders, Dube et al .[sup] in an uncontrolled trial of lithium in 20 hypomanic patients found that 95% patients showed significant improvement. There have been other studies to see the effectiveness of lithium in mood disorders. [sup],,,,,, Most of these studies have been open label, non-controlled, with assessment period varying from one month to 10 years and have sparingly used assessment scales. Lithium has been found useful in treating acute episodes, reducing number of episodes, duration and intensity of episodes, behavior and suicidal ideation. [sup],,, Studies have also looked for the socio-clinical correlates which influence the effectiveness of lithium. It has been shown that effectiveness of lithium is influenced by age and sex [sup] and good response is predicted by lesser number of episodes prior to initiation of lithium therapy, long duration of illness, [sup] and presence of family history of affective disorder. [sup], Patients with rapid cycling mood disorder and unipolar disorder were seen to respond poorly. [sup],, Studies have also evaluated the utility of single dose vs. divided dose of lithium in prophylaxis of mood disorders. One study concluded that single daily dose was more useful in reducing number of affective episodes than divided doses [sup] whereas another retrospective case review concluded that there was no difference in the efficacy and adverse effect in patients with once daily lithium versus lithium in divided doses. …