title: Mood stabilizer combinations: a review of safety and efficacy.
abstract: OBJECTIVE
  Polypharmacy is common in the treatment of refractory bipolar disorder. The purpose of this article is to review the safety and efficacy of mood stabilizers in combinations.
  
  
  METHODS
  A manual and computer (MEDLINE) search was performed for combinations of the most commonly used mood-stabilizing agents.
  
  
  RESULTS
  The authors review safety and efficacy data on the more frequently encountered combinations of established and putative mood 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 very useful, and potentially dangerous. One general rule that may reduce the risks of toxic drug interactions is to add medication to the patient's current regimen in modest doses and increase the dose slowly. The safest and most efficacious mood stabilizer combinations appear to be the mixtures of anticonvulsants and lithium, particularly valproate plus lithium. Once the mechanisms of the mood stabilizers are identified, it is possible that a more rational approach to combination therapy will emerge, based on synergism at the sites of action.
authors.affiliation: Psychopharmacology Unit, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA. mpfreeman@bics.bwh.harvard.edu
authors.forename: M P
authors.initials: MP
authors.lastname: Freeman
authors.forename: A L
authors.initials: AL
authors.lastname: Stoll
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000588:Amines; D000927:Anticonvulsants / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy* / Q000523:psychology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003024:Clozapine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D018967:Risperidone / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use*; D005680:gamma-Aminobutyric Acid
chemical_list: D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D014150:Antipsychotic Agents; D002121:Calcium Channel Blockers; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin; D008094:Lithium; D003024:Clozapine; D018967:Risperidone