Mood stabilisers

Question 1

Mechanism of action of lithium

Answer 1

Inhibits the formation of cAMP affecting a wide range of neurotransmitter pathways. May also promote cell survival and synaptic plasticity.

Question 2

Indications for Lithium

Answer 2

1. Acute treatment of mania
2. Prophylaxis in recurrent depression and bipolar mood disorder augmentation therapy in resistant depression
3. prevention of aggression in patients with learning disability

Question 3

Side effects of Lithium

Answer 3

• Polyuria and increased thirst.
• Fine tremor
• Metallic taste in mouth
• Weight gain
• Hypothyroidism – 20%
• Hyperparathyroidism
• Renal complications

Question 4

At what concentration is lithium toxicity reached?

Answer 4

Generally at concentrations >1.2mmol/L.

Question 5

What are the signs of lithium toxicity?

Answer 5

Ataxia, coarse tremor, poor coordination, slurred speech, confusion, muscle twitching progressing to coma, seizures and death at levels >2mmol/L.

Question 6

What is a consequence of Lithium use in pregnancy?

Answer 6

Ebstein’s anomaly 20 x more common

Question 7

How often is a patient taking lithium monitored?

Answer 7

1 week after initiation
Once steady state reached, can be monitored every 3 months

Question 8

What is the target dose of Lithium?

Answer 8

Usually aim for dose of 0.6-0.8 mmol/L for prophylaxis

Question 9

What is monitored in lithium therapy (other than lithium concentration?)

Answer 9

Weight,
U&Es inc. eGFR, Ca2+,
TFTs at baseline
then every months

Question 10

When should a person taking lithium be concerned about their lithium levels/contact a doctor?

Answer 10

If they have severe sweating, diarrhoea, vomiting.

Hot weather, alcohol, diuretics and NSAIDs.

Dehydration affects lithium levels and can cause renal complications.

Question 11

Indications for Lithium

Answer 11

• Mania
• Maintenance therapy in Bipolar affective disorder
• Can be used in treatment resistant depression

Question 12

How is lithium toxicity managed?

Answer 12

Stop lithium
Hospital admission
Hydration - fluids
Check levels repeatedly for one week
Osmotic diuresis
Dialysis as last resort

Question 13

Name 4 examples of other mood stabilisers

Answer 13

Sodium valproate
Carbamazepine
Lamotrigine
Antipsychotics e.g. Quetiapine, Haloperidol etc

Question 14

How would a patient present if they had hypercalcaemia secondary to hyperparathyroidism from Lithium therapy?

Answer 14

Lower back pain
Constipation
Headaches
Low mood
Difficulty concentrating