Mood Stabilisers

Question 1

What are mood stabilisers used for?

Answer 1

Bipolar disorder

Question 2

What are the groups of mood stabilisers?

Answer 2

Lithium
Anticonvulsants
Atypical antipsychotics

Question 3

Which is the most effective mood stabiliser?

Answer 3

Lithium

Question 4

What monitoring is required with lithium? Why?

Answer 4

Serum lithium levels
Weekly monitoring after dose change and then every 3 months when stable
This is done because lithium has a narrow therapeutic window
U&Es and TFTs every 6 months

Question 5

What else is lithium used for?

Answer 5

Reduction of self-harm in for example, personality disorders
Proven to reduce suicide
Also used to augment antidepressants

Question 6

What are the side effects of lithium?

Answer 6

GI disturbance (especially on initiation)
Metallic taste/dry mouth
Fine tremor
Polydipsia, polyuria - due to effects on ADH
Weight gain

Question 7

What are the long term effects of lithium?

Answer 7

Hypothyroidism (usually reversible when stopped, but can give thyroxine in the meantime if needed)
Renal impairment (lithium is renally excreted)
- usually irreversible and occurs at above therapeutic doses (if lithium level over 1)

Question 8

What are the symptoms of lithium toxicity?

Answer 8

Confusion
Coarse tremor
Incontinence
NV
Ataxia
Seizures

Question 9

What is the treatment for lithium toxicity?

Answer 9

Stop lithium
Supportive measures (IV fluid, dialysis if necessary, benzodiazepines for seizures)
Potential for toxicity increases if dehydrated so drink plenty of water to reduce toxicity risk

Question 10

Interactions with which drugs can increase levels of lithium dangerously?

Answer 10

NSAIDs
Loop diuretics
ACEi

Question 11

How are atypical antipsychotics used as mood stabilisers?

Answer 11

Quetiapine is the first line for bipolar disorder
- probably more to do with potential for lithium toxicity as opposed to efficacy
All antipsychotics have efficacy but typical are not licensed
Doses and monitoring are the same for psychosis

Question 12

Which anticonvulsants can be used as mood stabilisers and what do you have to look out for for each one?

Answer 12

Sodium valproate
- avoid in women of child bearing age due to teratogenicity. If giving to women have to make sure they are on depot contraception. Check LFTs before and soon after starting
Carbamazepine
Lamotrigine
- potential for Stevens Johnson Syndrome (gets better on its own when stopped)

Question 13

What sort of hypersensitivity reaction is Stevens Johnson Syndrome?

Answer 13

Type 4

Blistering of mucous membranes

Question 14

What are the side effects of anticonvulsants?

Answer 14

Thrombocytopenia (check FBC)
Sedation
Weight gain