| Considerations for prescribing mood stabilizers |
| Lithium: For classic, euphoric mania; for mixed manic episode; when a mood stabilizer alone is used to treat depression; when the mood stabilizer must be given in a single evening dose; in patients with liver disease, excessive alcohol use or cocaine use; and in patients older than 65 years |
| Valproic acid (Depakene): For classic, euphoric mania; for mixed manic episode; for mania with rapid cycling; for long-term maintenance therapy in patients who do not tolerate lithium because of the “flat” feeling lithium causes; in patients with structural central nervous system disease, renal disease and cocaine use; and in patients older than 65 years |
| Carbamazepine (Tegretol): For mixed manic episode; for mania with rapid cycling; in patients with structural central nervous system disease or renal disease |
| An antipsychotic agent |
| High- or medium-potency antipsychotic agents are used as adjunctive treatment for mania with psychosis or psychotic depression. |
| A benzodiazepine |
| Sleep and sedation in mania or hypomania; insomnia in depression |
| The combination of a mood stabilizer, an antidepressant and an antipsychotic |
| Psychotic depression |
| The combination of a mood stabilizer and an antidepressant |
| Nonpsychotic depression |
| A mood stabilizer alone |
| Milder depression in bipolar I disorder |
| Bupropion (Wellbutrin) |
| Bipolar depression |
| Patient with high risk of manic switch or rapid cycling |
| A selective serotonin reuptake inhibitor |
| Bipolar depression |