Mood stabilizer: a concept analysis and operationalization of a model

BackgroundThe term "mood stabilizer" is controversial in the literature. As there is no consensual meaning, its retirement has been suggested to avoid misuse. Nevertheless, it remains largely employed, and may carry an important meaning. This issue has not been approached using a validated qualitative inquiry. MethodsWe employed document analysis for reviewing definitions for mood stabilizer. Then, we used concept analysis as a qualitative methodology to clarify the meanings associated with the term. Based on its results, we built a theoretical model for a mood stabilizer, matching it with evidence for drugs used in the treatment of bipolar disorder. ResultsConcept analysis of documents defining the term unearthed four attributes of a mood stabilizer that were nested into the following ascending hierarchy: "not worsening", "acute effects", "prophylactic effects", and "advanced effects". To be considered a mood stabilizer, a drug had to reach the "prophylactic effects" tier, as this was discussed by authors as the core aspect of the class. After arranging drugs according to this scheme, "lithium" and "quetiapine" received the label, but only the former fulfilled all four attributes, as evidence indicates it has neuroprotective action. ConclusionThe proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. This could modify long-term outcomes and illness trajectory.