[Mood stabilizers--past, present and future].

Bipolar disorders are common, chronic, recurrent, and episodic mood disturbances, associated with variable dysfunctions in sleep, appetite, libido, activity, and cognition. These disorders are typically so severe that they impair occupational functioning. Until the discovery of lithium in the treatment of bipolar disorders, only electroconvulsive therapy was the available treatment of mania. After discovering the therapeutic effect of lithium in bipolar illness, the clinical outcome of the disorder has changed dramatically. Lithium has become the mainstay of the the treatment for bipolar disorders, however, the management of the illness has historically focused on the treatment of mania. Although the lifetime prevalence of bipolar disorder was originally estimated to be about 1%, the recent decade has brought more evidence, that the several clinical manifestations of the bipolar spectrum affects almost 5-6% of the general population. Lithium was absolutely helpful in euphoric mania, but with other types of disorder, especially bipolar depression and rapid cycling form, this efficacy significantly decreases. The newer mood stabilizers, carbamazepine and valproate have brought more possibilities to cover a broader zone of the bipolar spectrum. Although the new agents have offered a bit more protection against bipolar depression when used for prophylaxis, anyway, lithium, carbamazepine and valproate all are relatively ineffective against acute bipolar depression and rapid cycling. The third generation mood stabilizer lamotrigine has a broader and more effective efficacy in bipolar disorder, extending the therapeutic ranger especially in bipolar depression and in the difficult to treat rapid cycling subtype. This review provides a wide overview about the four most important mood stabilizers, lithium, carbamazepine, valproate and lamotrigine at the level of their synaptic and intracellular activities.