Mood Stabilisers

Question 1

What are mood stabilisers used for?

Answer 1

Used to stabilise mood in conditions like bipolar disorder, schizoaffective disorder, and may be used in treatment resistant depression (to augment normal treatment)

Question 2

Give some examples of mood stabilisers

Answer 2

Lithium Carbonate
Sodium Valproate
Carbamazepine

Question 3

What is the MOA of Lithium

Answer 3

Unknown mechanism
- may increase serotonin release
- may interact with NO signalling pathways
- has some neuroprotective properties
Reduces risk of suicide (unknown mechanism)

Question 4

What are the side effects of lithium

Answer 4

Tremor
Polyuria
Polydipsia 
Exacerbation of acne and psoriasis 
Metallic taste 
Ankle oedema
Weight gain 
Nephrogenic diabetes insipidus 
VERY TERATOGENIC

Question 5

Which conditions are patients who have used lithium long term more at risk of developing?

Answer 5

Hypothyroidism

Hyperparathyroidism

Question 6

What is the therapeutic index for lithium

Answer 6

0.4-1mmol/L

Question 7

What put a patient at risk of going into lithium toxicity

Answer 7

Dehydrated

Low on salt

Question 8

What monitoring is needed when taking Lithium Carbonate

Answer 8

Every 3 months

• blood tests to check lithium levels and U+Es
• ECG (arrhythmias)
• Weight

Question 9

Which drugs increase lithium reabsorption in the kidneys

Answer 9

NSAIDs
Thiazide diuretics
ACE inhibitors

Question 10

What is the MOA of sodium valproate?

Answer 10

Inhibits the breakdown of GABA (chief inhibitory NT)

More inhibition - less likely to go manic

Question 11

What are the side effects of sodium valproate?

Answer 11

Nausea 
Dose related tremor 
Hair loss with regrowth of curly hair 
Peripheral oedema
Pancreatitis 
Hyperandrogenism 
Weight gain 
Thrombocytopenia 
Rarely - hepatic failure 
Aggression 
TERATOGENIC

Question 12

What are the risks to newborns if a mother is taking sodium valproate?

Answer 12

Present in breast milk so increases risk of haematological disorders in breast fed newborns/infants

Question 13

What monitoring needs to be done with sodium valproate?

Answer 13

Monitor LFTs before and after 6 months of treatment

Question 14

What are the MOA of carbamazepine

Answer 14

Blocks voltage dependent sodium channels - inhibits repetitive neuronal firing (lower risk of mania)
decreases turnover of noradrenaline and dopamine - less likely to become depressed - less resorption

Question 15

What are the side effects of carbamazepine

Answer 15

Hepatic enzyme inducer

• induces own metabolism at high doses
• decreases half life of other drugs which are metabolised by CYP450
• increases ALP and gammaGT

Dizziness, diplopia, drowsiness, nausea, dry mouth, oedema, hyponatraemia, sexual dysfunction, general erythematous rash, chronic low WCC
TERATOGENIC

Question 16

What are the MOA of Lamotrigine

Answer 16

blocks sodium channels and decreases glutamate release

enhances action of GABA

Question 17

What are the side effects of lamotrigine

Answer 17

blurred vision 
arthralgia 
back pain 
diarrhoea 
diplopia 
dizziness and drowsiness 
dry mouth 
headache 
Insomnia 
Rash 
tremor 
Vomiting

Question 18

What is lamotrigine used for?

Answer 18

Most effective in preventing recurrent depressive episodes of bipolar disorder