Deprescribing Mood Stabilizers

This chapter reviews the literature on lithium withdrawal and provides strategies on how to reduce the risk of relapse through such measures as slow tapers. Combinations of mood stabilizers such as lithium, divalproex, carbamazepine, and lamotrigine are used frequently and recommended even with the approval of several second-generation antipsychotic medications as mood stabilizers. As patients grow older, the potential nephrotoxicity and hepatotoxicity of these medications can become a significant consideration. The question of misdiagnosis of mood instability and off-label use occurring in personality disorders and substance abuse is also addressed. Psychotherapeutic interventions such as psychoeducation, family therapy, and cognitive behavioral therapy that support the treatment of bipolar disorder are described as a part of the deprescribing process and illustrated by case examples.