Mood Stabilizers: Course and Duration of Therapy, Withdrawal Syndromes, and Resistance to Therapy

Despite different available pharmacological frameworks, mood stabilizers are widely acknowledged as a group of agents prescribed in the treatment of bipolar disorders. In this chapter we use an indication-based approach to describe acute and maintenance treatment with mood stabilizers encompassing lithium, anti-convulsants, and antipsychotics in adult patients. Primary and secondary clinical evidence as well established guidelines are reviewed focusing on the included agents. Further, we elaborate on clinical manifestations related to the discontinuation of mood stabilizers, although these drugs do not typically possess the potential for withdrawal syndromes. Lastly, therapeutic options for treatment-refractory forms of bipolar disorders including pharmacological and non-pharmacological interventions are discussed. Summing up, the armamentarium of mood stabilizers has not been essentially revised during the past decades; older agents still comprise a core part of routine pharmacotherapy in bipolar disorders. However, prescription of mood stabilizers remains a tricky business, and clinicians need to develop a comprehensive understanding of profiles of action and adverse drug reactions in order to enhance efficacy and safety. © Springer Nature Switzerland AG 2022.