This article helps us to understand why most of us need a cocktail of prescribed medicines to treat and prevent hypomania, mania, depression, anxiety, insomnia, etc. In summary, there is no one medication that can treat all of these conditions and symptoms.
People who are diagnosed bipolar should expect to need two or more medications because there are four general concerns: (1) short-term treatment of mania, (2) long-term prevention of mania, (3) short-term alleviation of depression, and (4) prevention of relapse into depression.
No known single medication accomplishes all of these goals. https://www.ncbi.nlm.nih.gov/b...
"8.1.3. Mood stabiliser – a term best avoided
There is confusion over what the term ‘mood stabiliser’ refers to. Although the term is widely used in clinical practice, there is no universally accepted definition. The most rigorous definition of a mood stabiliser is that it is a drug that treats both poles of bipolar disorder and is protective against a return of both poles (Bauer & Mitchner, 2004).
A less stringent criterion is that it is an agent that is effective in treating one pole of the disorder and in preventing a recurrence at that pole but that does not increase the risk of the opposite pole of the illness appearing.
Adopting either criterion still leaves open the issues of how one (1) defines effectiveness, that is, what additional benefit above placebo is required to regard a drug as effective and (2) how one distinguishes between acute and maintenance treatment.
It has been argued that the most stringent definition of a mood stabiliser (that is, a drug that has short and long-term efficacy at both poles) is only fulfilled by lithium. However, even with lithium the data relating to efficacy in the treatment of bipolar depression is limited and that which does exist indicates only a modest effect.
In contrast there is stronger evidence that lithium is effective in the acute and long-term treatment of mania. If one required evidence from at least two RCTs to indicate a clinically significant benefit in the acute and long-term treatment of both phases of bipolar disorder (that is, efficacy in four separate domains) then no drug would fulfil the criteria for a mood stabiliser.
For this reason the less stringent criterion of acute and long-term efficacy and prophylaxis at one pole, without evidence of a worsening of the opposite pole, seems a more clinically useful definition and is the one that is adopted by many professionals.
Even this restricted definition of a mood stabiliser is associated with problems. The term may imply that these drugs cause absolute tranquillity of mood in any setting; in reality RCTs indicate that drugs labelled as mood stabilisers are effective, to varying degrees, in the treatment and prophylaxis of a limited number of affective syndromes in bipolar disorder, with most RCTs being limited to major depression or mania.
To extrapolate from this to assume that these drugs are effective in sub-syndromal forms of these syndromes plus other affective states is to go beyond the evidence.
For some patients the idea of a mood stabiliser, perceived as a drug that ‘flattens’ mood, may be off-putting. Another concern is that ‘mood stabiliser’ becomes a marketing label used by the pharmaceutical industry to promote drugs in bipolar disorder.
In this context the term ‘mood stabilisers’ may lead prescribers to conclude all so-called ‘mood stabilisers’ have identical properties rather than to question the evidence for each drug in turn."