Drug Therapies - Mood Stabilizers Flashcards
What are mood stabilizers indicated for?
BPD
Cyclothymia
Schizoaffective
What are the classes of mood stabilizers?
Lithium
Anticonvulsant
What makes lithium unique
Only drug proven to reduce suicide rates
What factors would predict a good response to lithium?
Prior use or Family member with it
Pure mania
Mania followed by depression
What tests do you do before prescribing lithium?
U&Es + TSH
Pregnancy test (& if possible avoid in women of Child bearing age)
What are the major side effects of lithium?
Gi distress
Hypothyroid
Reduces seizure threshold
Polyuria/polydipsia due to ADH antagonism. More severely causes Interstitial renal fibrosis –> renal failure
What symptoms should you warn the patient about re lithium toxicity?
Vomiting
Diarrhoea
Ataxia
Slurred speech
Dizziness
Nystagmus
What are the major anti-convulsants used as mood stabilizers?
Valproic acid (aka Depakote)
Carabamazepine
Lamotrigine
What is valproic acid particularly good for?
Mania prophylaxis, but not as good for depression
However its better tolerated than lithium
What predicts a good response to valproic acid?
Comorbid substance abuse
Mixed episodes
Rapid cycling (4 or more episodes a yr)
Comorbid anxiety disorders
What tests should you do before starting valproic acid?
Baseline LFTs & FBC
Pregnancy test (very rarely ok to use valproic acid in women of child bearing age, risk is too high)
What’s the major side effect of Valproic acid?
Thrombocytopenia & platelet dysfunction
What is Carbamezepine used for?
First line in acute mania and mania prophylaxis
Its most effective for mixed episode patients and rapid cyclers
What should you test befor eusing carbamazepine?
Baseline FBC, LFT & ECG
What should you be specially careful of with carbamazepine?
It interacts with a LOT of drugs
So you need to check before using it
