MOOD STABILIZER COMBINATIONS - A REVIEW OF SAFETY AND EFFICACY

Objective: Polypharmacy is common in the treatment of refractory bipol ar disorder. The purpose of this article is to review the safety and e fficacy of mood stabilizers in combinations. Method: A manual and comp uter (MEDLINE) search was performed for combinations of the most commo nly used mood-stabilizing agents. Results: The authors review safety a id efficacy data on the more frequently encountered combinations of es tablished and putative moon stabilizers. Conclusions: There have been few controlled studies of the use of combinations of mood stabilizers. The interactions of such combinations are sometimes complex, often ve ry useful, and potentially dangerous. One general rule that may reduce the risks of toxic drug interactions is to add medication to the pati ent's current regimen in modest doses and increase the dose slowly. Th e safest and most efficacious mood stabilizer combinations appear to b e the mixtures of anticonvulsants and lithium, particularly valproate plus lithium. Once the mechanisms of the mood stabilizers are identifi ed, it is possible that a more rational approach to combination therap y will emerge, based on synergism at the sites of action.