Q:  If one is taking a mood stablizer and they weren't bipolar, what would the effects be, if any?
 

Dear Christine -- 
The nice folks at Bipolar World reminded me along with your letter that I wrote something about this a few years ago, pretty much the same question, which they noted is a very common one; so they suggested I have a shot at an "update".  Here's the old reply which still applies pretty well You'll see the main message is kind of agreeing that the main thing is to try to figure out diagnostically whether this is the right general direction; and there is "new news", regarding bipolar diagnosing, which I'll show you in a moment. 

But as far as new news regarding the risks of mood stabilizers, the story is rather the same except more so:  the list of medications regarded as "mood stabilizers" has grown. Most psychiatrists (and many primary care doctors) now routinely use a group of medications called "atypical antipsychotics" as well as lithium, Depakote, and carbamazepine (Tegretol).  The atypicals, as we call them, might sound like "big guns" for a small problem, with that "antipsychotic" term in there. But the term reflects how they grew up, if you will, not so much what they actually do: it turns out that all five of them clearly have anti-manic effects and most of them if not all of them also have pretty solid antidepressant effects. Two have been officially shown to prevent relapse once you're well and most of them seem to have that capacity; ultimately I think all will be shown to have it. Here's a page describing them.  

Looking at "antipsychotics" as a medication option when you're not sure you have "bipolar" in the first place is surely not very comforting.  This group has some clear risks, too: weight gain is very common, and we even have to watch out for them causing diabetes. So the whole idea of these medications is pretty scary if you don't clearly need your symptoms controlled.  However, some people can take them, often at very low doses far below what we use routinely for severe mania, with no side effects and great benefit (and we watch their glucose and their cholesterol and their weight to make sure those don't go up either). 

As for the shift in diagnostic thinking, there is stronger support from mood experts for thinking in terms of a "bipolar spectrum".  In other words, instead of asking "do you have bipolar disorder?", we ask "how much bipolarity might you have?" Most people on the "mood spectrum" have depression, but some will also have a bipolar component. So we try to identify where on that spectrum you are.  The Harvard bipolar clinic now has a diagnostic system they're recommending across the U.S. which also gives you a score on a "spectrum" rather than a yes or no, illustrating that they are solidly behind this way of thinking.  There's even a paper/pencil test you can take along those lines. In general there is a move toward de-emphasizing the search for hypomania/mania, as the basis for your diagnosis; and increasing the emphasis on the other factors we've been calling "bipolar soft signs".  These are described on my "diagnosis" page about Bipolar II; see the "soft signs" section. 

I hope you'll look at those links as they really change the way one thinks about bipolar disorder diagnosis, I think. Good luck with the process. 

Dr. Phelps

Published September, 2005