Mood Stabilisers

Question 1

Name 3 mood stabilisers?

Answer 1

Lithium, the anticonvulsants, valproate and carbamazepine

Question 2

How is lithium thought to work?

How are valproate and carbamazepine thought to work?

Answer 2

• By modulating the neurotransmitter induced activation of second messenger systems
• Via the GABA system: carbamazepine is a GABA antagonist and valproate inhibits GABA transaminase

Question 3

-What is lithium used to treat?
What is valproate used in the treatment of?
-Carabamazepine?

Answer 3

• Acute mania, prophylaxis of bipolar affective disorder, treatment resistant depression (lithium augmentation) , adjunct to antipsychotics in schizoaffective disorder and schizophrenia, and aggression/impulsivity
• Epilepsy, acute mania, prophylaxis of bipolar affective disorder
• Epilepsy, prophylaxis of bipolar affective disorder (if unresponsive to lithium), rapid cycling bipolar disorder, treatment resistant mania, depression or schizophrenia, trigeminal neuralgia, impulse control disorders

Question 4

What is its therapeutic range and how is it excreted?

How and what is monitored?

Answer 4

• Has a narrow therapeutic range; 0.5-1 is therapeutic, >1.5 is toxic
• Excreted almost entirely by the kidneys, clearance is reduced in renal insufficiency and sodium depletion.
• Drugs such as NSAIDS and ACEI can also increase lithium levels
• Blood levels need to be monitored weekly until a therapeutic level has been stable for 4 weeks. Then bloods should be checked every 3 months, renal function every 6 months and thyroid function every year

Question 5

Side effects and CIs of Lithium?

Answer 5

S.Es; thirst, polydipsia, polyuria, weight gain, oedema, fine tremor, worsening of skin problems, concentration problems, hypothyroidism, impaired renal function, t-wave flattening or inversion, leucocytosis, teratogenicity.

Ci: pregnancy, renal insufficiency, thyroid disease, cardiac conditions, neurological conditions (e.g. parkinsons, huntingtons)

Question 6

What are the toxicity signs of lithium?

Answer 6

-N+v. apathy, ataxia, muscle weakness, impaired consciousness, dysarthria, oliguria, hypotension, convulsions, coma

Question 7

What should be checked before and monitored soon after starting Carbamazepine and sodium valporate?

Answer 7

-LFTs and haematological functions should be checked prior to and soon after starting due to risk of serious hepatic and blood disorders

Question 8

What are the S.Es of sodium valporate?

Answer 8

-Increased appetite, weight gain, ankle swelling, hair loss, n+v, tremor, haematological abnormalities, raised liver enzymes

Question 9

What are the S.Es of carbamazepine?

Answer 9

n+v, skin rashes, blurred or double vision, ataxia, drowsiness, fatigue, hyponatraemia, fluid retention, haematological abnormalities, raised liver enzymes