The term ‘‘mood stabilizers’’ refers to a heterogeneous group of medications that are effective in the treatment of bipolar disorder, an illness characterized by recurrent episodes of mania and major depression. The list of mood stabilizers includes lithium, several anticonvulsant medications, and atypical antipsychotic medications. For some of these medications, there have been randomized, placebo-controlled studies demonstrating efficacy in reducing the severity and frequency of illness episodes (Kahn et al., 2000). For other medications, the evidence supporting therapeutic use in mood disorders is more anecdotal or preliminary. Late-onset bipolar disorder beginning after 50 years of age is more likely to be associated with comorbid medical or neurologic condition, or their treatments (McDonald, 2000; Depp and Jeste, 2004). A number of medications have been known to precipitate manic episodes. These include antiparkinsonian medications, corticosteroids, anticholinergic agents, and antidepressants. In addition, manic episodes may develop in patients with Huntington’s disease, multiple sclerosis, brain tumors, seizure disorders, dementia, neurosyphilis, human immunodeficiency virus (HIV), and some poststroke syndromes. The goal of long-term psychiatric management is to minimize affective upheaval and to diminish frequency of mood cycling. Psychotic symptoms are common in bipolar disorder, and severe behavioral disturbances such as physical aggression can occur as well during manic episodes. Depressive episodes are accompanied by a risk of suicide. Given the potential for these severe complications, and the need for continual medication reassessment and adjustment, the long-term pharmacologic and psychologic treatment of bipolar disorder is best managed by a psychiatrist. Lithium, the oldest of the mood-stabilizing medications, is also considered to be the ‘‘gold standard’’ of treatment against which all other potentially mood-stabilizing medications are compared. It is still the treatment of choice for many patients with bipolar disorder, and it has been approved by the U.S. Food and Drug Administration for treatment of manic episodes and for maintenance therapy. At least eight placebo-controlled, randomized trials have shown lithium to have efficacy in maintenance treatment of bipolar disorder (Goodwin, 2002). Lithium is effective in reducing risk of recurrent episodes of both mania and depression, although studies have suggested greater superiority in reducing risk of manic episodes.
A case of methamphetamine use disorder presenting a condition of ultra-rapid cycler bipolar disorder
