Discussing Mood Stabilizers With Patients With Bipolar Disorder

In this video from on-site at the 2023 NP-Institute, Psych Congress Network Bipolar Disorder Excellence Forum Section Editor Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, clinical professor at the University of Illinois at Chicago, examined using mood stabilizers in patients with bipolar disorder. Dr Carbray emphasized the importance of patient education and collaborative decision-making, how to address patient fears, and cleared up common myths and misconceptions surrounding mood stabilizers. 

Dr Carbray discussed this and other topics at the 2023 Psych Congress NP-Institute in Boston, Massachusetts. Save the date for NP Institute In-Person in 2024, from March 20 to 23, in San Diego, California! For more information, visit the meeting website. Keep up with pre-conference meeting coverage in our newsroom. 

Read the Transcript: 

Psych Congress Network: What advice do you have for clinicians in talking to their patients about mood stabilizers?

Julie Carbray, PhD: We first start with our patients in talking about medication decisions. Will I go on to a mood stabilizer and what does that look like? So we want to educate around efficacy. We want to let them know about monitoring and the ways that we'll do that and have some shared decision-making, what the patient would like to see in their ongoing treatment of their illness, and what mood stabilizers could bring to the table. With this discussion, we'll explore their fears, we'll explore some ideas or misconceptions they may have about mood stabilizers, sometimes stigma even, and then we'll draft a plan. If we are to try a mood stabilizer, what would that look like? How will we monitor and how will we address some of their fears along the way?

PCN: What are some common myths about mood stabilizers? 

Dr Carbray: Some common misconceptions about using mood stabilizers might include they're very difficult to manage, they're very dirty, having many side effects, that they're not as well tolerated as we'd like them to be. And actually, evidence would suggest they're not as difficult as many clinicians might initially think about, or patients more importantly worry about. Although they might take a little longer to work than say a second-generation atypical, it's a matter of weeks where you'll begin to see some improvement in mood. So hanging in there and discussing expectations, managing those expectations is a real pearl. I would say as a clinician, you want to really help your patient to manage expectations, to understand what it is that they're looking for in a mood stabilizing medication and how that might look different from other medications they've had in the past. Also, you want to address maybe blood monitoring or other monitoring and what that would look like.

Some of my patients have said to me, "I don't want to go on lithium. That means I have to have a needle stick like every week." They sort of think that it might be something like Clozapine. That's not really the case. You will need to have more frequent blood monitoring as you're ramping up the dose of a mood stabilizer, but once there's stability, you're looking at every 6 months or so for monitoring, and so that becomes less of a concern. So really talking and educating patients about risk versus benefit, addressing those fears would be the biggest tools I would say clinicians need to feel more comfortable and patients need to help them choose this as a treatment that's really going to benefit them in ways other agents will not.

As your Psych Congress bipolar section editor, I just want to welcome you back again. Keep coming back again for updates on the treatment of bipolar disorder, for new research coming out around managing this disorder, and pearls that will continue to help you to best help your patients who are struggling with managing the effects of this disorder on their every day.

Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana.