What Is The Difference Between Antipsychotics and Mood Stabilizers When Treating Bipolar Disorder?

In this video, Jonathan Meyer, MD, voluntary clinical professor of psychiatry at the University of California, San Diego, discusses the difference between antipsychotics and mood stabilizers in the treatment of bipolar disorder. Dr Meyer highlights that for long-term maintenance treatment, especially for individuals with a history of mania, lithium is considered the best mood stabilizer. This choice in medication can be especially important when it comes to suicide risk, as patients with bipolar disorders are significantly more likely to have a completed suicide. Dr Meyer indicates lithium in this sense too, as it has been shown to reduce the risk of completed suicide by fivefold. 

Dr Meyer discussed the uses and benefits of lithium in his session "Lithium for Bipolar Disorder: What Clinicians Need to Know" at Psych Congress Elevate 2023 in Las Vegas, Nevada. To catch up on other updates and insights from Elevate, visit our newsroom.

Read the Transcript:

Psych Congress Network: Could you walk us through the difference between antipsychotics versus mood stabilizers for the treatment of bipolar disorder?

Dr Jonathan Meyer: We recognize bipolar disorder can be approached with medications of a number of different classes. Increasingly over the last two decades, people have been using second-generation antipsychotics; initially for mania treatment and in some instances for maintenance.

One thing we've learned is that while more than one medicine may have anti-manic properties, it doesn't do the same thing as another medication on second messenger systems. And what's the proof of this? Well, we know that both antipsychotics and lithium have anti-manic properties, but once we get past that early treatment phase, when you go into maintenance studies, people on atypical monotherapy have much higher rates of treatment failure than those on lithium.

This is really the best evidence that while they may have overlapping efficacy at some point in the illness, for maintenance treatment, if you have a history of mania, you need to be mood stabilized and lithium is the best drug for that purpose.

Psych Congress Network: Could you discuss the suicide risk in patients with BD and some of the tools clinicians have at their disposal to advise this risk?

Dr Meyer: We know that the risk for completed suicide may be 10- or even 20-fold higher than the general population. One thing we've learned from a number of studies is that number one, lithium reduces this risk significantly approximately fivefold, and we see no similar risk reduction for valproate.

This is true both in retrospective studies as well as within subject studies where each person is their own control. During periods on lithium, you see a reduction in suicidality, but you do not see a comparable reduction for any period on valproate. So most importantly, when people have a history of suicidality, lithium needs to be the preferred mood stabilizer to help reduce this risk. And one thing we've also seen in these within subject studies is that this is true even for people with bipolar disorder and co-occurring substance use disorders.

Jonathan Meyer, MD, is a voluntary clinical professor of psychiatry at University of California, San Diego, and a distinguished life fellow of the American Psychiatric Association. Dr Meyer is a graduate of Stanford University and Harvard Medical School, finished his adult psychiatry residency at LA County-USC Medical Center and completed fellowships there in Consultation/Liaison Psychiatry and Psychopharmacology Research. Dr Meyer has teaching duties at UC San Diego and the Balboa Naval Medical Center in San Diego, and is a consultant to the first episode psychosis program at Balboa NMC.