The Gold Standard: Using Mood Stabilizers in the Treatment of Bipolar Disorder

In this video, 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, delves into the crucial considerations for managing bipolar disorder. Dr Carbray highlights lithium as the gold standard mood stabilizer, exploring its efficacy in treating acute mania and serving as a reliable maintenance medication, and addresses the pitfalls of SGA monotherapy. Discover how careful monitoring, proper dosing, and patient education can mitigate associated risks and positively impact long-term therapy outcomes.

Dr Carbray discussed this and other topics at the 2023 Psych Congress NP-Institute in Boston, Massachusetts. Save the date for next year's NP Institute In-Person, March 20-23, 2024, 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 is the gold standard mood stabilizer for a patient with a history of mania? What major risks are associated with that treatment?

Julie Carbray, PhD: Lithium has been the gold standard of care for persons with bipolar disorder in the mood stabilizer class of medications. Not only can it treat acute mania, but also serves as an excellent maintenance medication to prevent further episodes of mania. And some of the risks involved with lithium can be mitigated by careful monitoring and by dosing, and just really educating patients around what to expect in managing their lithium therapy across their day, across their week, and across their lifespan, and addressing concerns very early on to mitigate any challenges patients may have with adverse events as they continue this therapy really can result in those positive outcomes that study after study has demonstrated in really helping patients with recovery from this illness.

Psych Congress Network: Why should SGA monotherapy be avoided in patients with bipolar one disorder? Do you have any suggested alternatives?

Dr Carbray: There's a place for second-generation atypicals in the management of mania, also in the management of bipolar depression. But remember, bipolar disorder has those two poles of mood dysregulation. You may have a patient in a depressive phase of their illness, but around the corner there might be a cycle that might provoke a manic episode. Mood stabilizers really do keep the ground steady for patients when those episodes of illness might break through and contribute to significant functional impairment. Mood stabilizers have a critical role in really setting the stability straight and SGAs have a role for, say, psychosis or acute mania as adjunctive treatment if we're still struggling, say, with depressive symptomatology. But they have a critical role in helping patients with bipolar illness and should almost always be considered when you have a patient with bipolar disorder.

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.