OBJECTIVE: The term “mood stabilizer” is widely used in the context of treating bipolar disorder, but the U.S. Food and Drug Administration (FDA) does not officially recognize the term, and no consensus definition is accepted among investigators. The authors propose a “two-by-two” definition by which an agent is considered a mood stabilizer if it has efficacy in treating acute manic and depressive symptoms and in prophylaxis of manic and depressive symptoms in bipolar disorder. They review the literature on the efficacy of agents in any of these four roles to determine which if any agents meet this definition of mood stabilizer. METHOD: The authors conducted a comprehensive review of English-language literature describing peer-reviewed, U.S. Agency for Healthcare Research and Quality class A controlled trials in order to identify agents with efficacy in any of the four roles included in their definition of a mood stabilizer. The trials were classified as positive or negative on the basis of primary outcom...

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What Is a “Mood Stabilizer”? An Evidence-Based Response

Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendation: [I] Recommended with substantial clinical confidence. [II] Recommended with moderate clinical confidence. [III] May be recommended on the basis of individual circumstances.

https://focus.psychiatryonline.org/doi/pdf/10.1176/foc.1.1.64

Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)

• Present clinical and research methods of differential diagnosis of schizophrenia and affective psychoses rely very heavily on presenting symptoms and signs, especially in acute psychosis. We have reviewed studies bearing on this issue, including studies of the phenomenology of psychotic illness, outcome, family history, response to treatment with lithium carbonate, and cross-national and historical diagnostic comparisons. We conclude that most so-called schizophrenic symptoms, taken alone and in cross section, have remarkably little, if any, demonstrated validity in determining diagnosis, prognosis, or treatment response in psychosis. In the United States, particularly, overreliance on such symptoms alone results in overdiagnosis of schizophrenia and underdiagnosis of affective illnesses, particularly mania. This compromises both clinical treatment and research.

Diagnosis in schizophrenia and manic-depressive illness: a reassessment of the specificity of 'schizophrenic' symptoms in the light of current research.

Disciplinary fragmentation and nosological and semantic controversies have obscured the impressive advances made in the area of depressive disorders during the past decade. This article is an attempt to translate data derived from psychodynamic, sociobehavioral, and neurobiologic research into a clinically meaningful framework. We review ten models of depression with special emphasis on newer models supported by empirical and experimental studies, and present a new model, which incorporates and synthesizes findings from different schools. Depressive illness is conceptualized as the feedback interaction of three sets of variables at chemical, experiential, and behavioral levels with the diencephalon serving as the field of action.

https://jamanetwork.com/journals/PSYCH/articlepdf/491325/archpsyc_32_3_001.pdf

Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame.

Four acutely agitated patients with diagnoses of mania were treated with a combined regimen of lithium carbonate and high doses of haloperidol—a form of therapy that had been used previously in Metropolitan Hospital without reported adverse effects. In these four, severe encephalopathic syndromes developed. Symptoms consisted of lethargy, fever, tremulousness, confusion, and extrapyramidal and cerebellar dysfunction, accompanied by leukocytosis and elevated levels of serum enzymes, blood urea nitrogen, and fasting blood glucose. Two patients suffered widespread, devastating, irreversible brain damage. Two others were left with persistent dyskinesias. Causal factors have not been identified. ( JAMA 230:1283-1287, 1974)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=358446&pdfFileName=jama_230_9_018.pdf

Lithium Carbonate, Haloperidol, and Irreversible Brain Damage

Controlled evaluation of lithium and chlorpromazine in the treatment of manic states: An interim report *

A controlled double-blind evaluation of lithium and chlorpromazine in acute manic states is reported.

Analysis of the results shows that lithium produced a highly significant improvement in the manic-depressive (manic phase) patients but no significant change in the schizoaffective (excited) patients. Chlorpromazine produced significant improvement in both diagnostic groups.

An analysis of the differences of the two treatments showed that lithium produced the greater change in the manic-depressives, whereas chlorpromazine produced more change than lithium in the schizoaffective group. These differences, however, did not reach statistical significance.

The importance of diagnosis for treatment outcome is discussed. Lithium is an effective and specific agent for the control of the manic phase of manic-depressive illness.

Comparative Effects of Lithium and Chlorpromazine in the Treatment of Acute Manic States

The effect of acute and chronic administration of lithium carbonate on electroencephalogram (EEG), behavior and serum electrolytes was studied in 10 patients. Five patients, 3 of whom are manic-depressive in the manic phase, and 2 who were schizo-affective in the excited phase, received lithium as p

Gordon Johnson

Papers

Controlled evaluation of lithium and chlorpromazine in the treatment of manic states: An interim report *

Comparative Effects of Lithium and Chlorpromazine in the Treatment of Acute Manic States

The effects of lithium on electroencephalogram, behavior and serum electrolytes

Antidepressant effect of lithium.

Nifedipine-induced depression.