Mood Stabilisers

Question 1

What is the indication for lithium?

Answer 1

Management of acute manic or hypomanic episodes and prophylaxis of bipolar disease.

Question 2

How long does lithium take to work?

Answer 2

7-14 days

Question 3

What tests must be performed before starting lithium?

Answer 3

Weight, BP and pulse
Renal function
FBC, creatinine, TFT, calcium (plasma lithium levels are increased by sodium depletion)
Baseline ECG

Question 4

What are the important drug interactions of lithium?

Answer 4

Any medicines that can impair renal function or cause hyponatraemia:
ACEi
diuretics
NSAIDs
SSRIs

Question 5

What are the contra-indications for lithium?

Answer 5

Cardiac disease
Significant renal impairment
Addison’s disease and patients with low sodium
Untreated hypothyroidism

Question 6

What should you inform patients about when taking lithium?

Answer 6

Symptoms of toxicity
Regular fluid intake
Need for compliance in taking the medication
Dont crash diet
Avoid NSAIDs
Dont exceed more than 1-2 units of alcohol per day
It takes 3-6 months to become established on lithium

Question 7

How often should lithium levels be checked?

Answer 7

Five days following start of therapy or changing dose
Then weekly until levels stable for 4 weeks
Then every 3 months
More frequent monitoring in those with interacting medication or in renal, thyroid or cardiac disease

Question 8

Above what level is lithium toxicity?

Answer 8

> 1.5mmol/L

Question 9

What are the common side effects of lithium?

Answer 9

Abdominal pain
Nausea
Metallic taste in mouth
Fine tremor
Thirst, polyuria and impaired urinary concentration
Weight gain and oedema

Question 10

What are the common symptoms of lithium toxicity?

Answer 10

Anorexia, diarrhoea and vomiting
Drowsiness, apathy and restlessness
Dysarthria
Dizziness, ataxia, inco-ordination, muscle twitching, coarse tremor
In severe cases: hyper-reflexia, convulsions, collapse, renal failure, dehydration, hypokalaemia