mood stabilizer

Question 1

Li

Answer 1

DOC in acute mania, and prophylaxis for manic/depressive episodes, augmentation for unipolar depression
not good for mixed, rapid cyclers
decreased risk of suicide
requires titration, narrow therapeutic index (0.6-1.2)- over 1.5 is toxic, over 2 is lethal
regularly monitor lithium (5 days after new dose), TSH, creatinine/BUN levels
LMNOP- tremors, nephrogenic DI, hypothyroidism, teratogenic (Ebstein’s anomaly)
increase levels- thiazide diuretics
decrease levels- NSAIDs

response in 2-4 weeks: if pt. is highly manic/active before it kicks in, add another agent (better to add depakote/carbamazepine than to switch away from lithium)

discontinue slowly (decrease risk of relapse)

Question 2

Valproic Acid (Depakote, Depakene)

Answer 2

Anticonvulsant
acute mania, mixed episodes, rapid cycling, prophylaxis (not FDA, but commonly used)
rapid onset- loading dose easier than Lithium (less risk of acute toxicity)
good for migraine prophylaxis
regularly monitor CBC, LFTs
fatal hepatotoxicity (rare), pancreatitis, teratogenic (NTD), tremor, weight gain (careful with atypical antipsychotics)

Question 3

carbamazepine (tegretol)

Answer 3

Anticonvulsant
acute mania, mixed episodes, rapid cycling, prophylaxis (less effective for depressed phase)
good for trigeminal neuralgia
regularly monitor CBC, LFTs
CNS (vertigo, nyztagmus, ataxia), blood dyscrasias (agranulocytosis, aplastic anemia), SJS, teratogenic (NTD), drug interactions (autoinduction)
Oral contraceptive + CBZ = pregnancy

Question 4

lamotrigine (lamictal)

Answer 4

Anticonvulsant
bipolar depression prophylaxis (little efficacy for acute mania)
pts. predominantly depressed and want to avoid weight gain/sedation
Benign rash (10% risk), SJS (prevent with slow titration)
decrease dose by 50% with Valproic acid (V increases L levels)

Question 5

oxcarbamazepine (trileptal)

Answer 5

as effective as CBZ, but better tolerated (not FDA approved)

less SE- rash, hepatic tox

Question 6

gabapentin (neurontin)

Answer 6

adjunct for BPD to help with an, sleep

Question 7

topiramate (topamax)

Answer 7

used for weight loss in psych puts

may cause cognitive slowing

Question 8

atypical antipsychotics

Answer 8

QRAZO + symbyax

does not worsen deep- unlike typical antipsychotics- quetiapine has anti-dep effects

Question 9

2 or more manic episodes

Answer 9

always use long term prophylaxis