Mood stabilizers Flashcards
What are the 3 categories of mood stabilisers?
Lithium
Anticonvulsants
Antipsychotics
How do anticonvulsants work to stabilise mood?
They calm hyperactivity in the brain.
What other diseases are anticonvulsants used for?
Migraine
Epilepsy
What type of bipolar disorder reacts well to anticonvulsants?
Those with rapid cycles.
What is the 1st line treatment for bipolar?
Lithium
What is the prophylaxis for bipolar?
Lithium - for both manic and depressive episodes.
What tests must be done before starting lithium?
U&E
TSH
Pregnancy
What congenital abnormality is associated with lithium?
Abstains anomaly (heart defect)
When is lithium likely to cause a congenital anomaly?
1st trimester
When does lithium reach a steady state?
After 5-7 days
When most lithium be checked?
5-7 days after starting.
At least 12hrs after the last dose.
What is the goal level of lithium?
0.6-1.2
when must lithium, TSH and creatinine be checked?
Lithium - every 3 months
TSH and creatinine - every 6 months
What is the first line treatment for a manic episode?
Antipsychotics
Lithium can also be used (isn’t 1st line)
When is lithium indicated?
1st line bipolar disorder
option in acute manic episode
Unipolar depression when theres no response to antidepressants
What are the side effects of lithium?
Nausea Vomiting Tremor ADH blocked - polyuria, polydipsia Hypothyroidism (weight gain, cold sensitive, slow HR, mental slowness, hair loss, acne) Intention tremor reduced seizure threshold Renal fibrosis
What are the toxic levels of lithium, mild, moderate and severe?
Mild = 1.5-2 Moderate = 2-2.5 Severe = >2.5
When should lithium not be used?
For someone with alcohol abuse - causes toxicity if they’re dehydrated
What are the 3 main anticonvulsants used as mood stabilisers?
Valproic acid
Carbamazepine
Lamotrigine
What condition is valproic acid given as a prophylaxis?
Migraine
What are the side effects of valproic acid?
Tremors GI symptoms Alopecia Sedation Weight gain Liver toxicity AV conduction delay
What defects can valproic acid cause if used during pregnancy?
Neural tube defects
Is valproic acid good as a prophylactic in bipolar?
Good as a manic prophylaxis
Not as good as lithium at depression prophylaxis
Why might lithium be given for bipolar prophylaxis rather than lithium?
Better tolerated
What tests must be done before using valproic acid?
LFTs
Pregnancy test
FBC
When is a steady state achieved using valproic acid?
4-5 days
When must levels of valproic acid be checked?
After 4-5 days
12 hours after last dose
What is the goal for valproic acid levels?
50-125
What conditions use carbamazepine as their 1st line treatment?
Trigeminal neuralgia
Acute mania
Mania prophylaxis
Which patients benefit from carbamazepine?
rapid cyclers
Which tests must be done before using carbamazepine?
LFT
FBC
ECG
What side effects are seen using carbamazepine?
Rash double vision ataxia liver toxicity Teratogenic Av conduction delays Cytochrome P450 induction Water retention (hyponatraemia)
When is a steady stage achieved using carbamazepine?
after 5 days
What are the teratogenic effects of carbamazepine?
Cleft pallet
Spina bifida
When must carbamazepine be checked?
after 5 days
12 hours after last dose
**Must check again and change dose after 1 month - it induces its own metabolism
What is the goal level of carbamazepine?
4-12mcg/ml
What is the main thing to remember when using lamotrigine?
If the patient stops their medication for more than 5 days, they need to start at the lowest dose again then titrate up.
What is the titration pattern for lamotrigine>
25mg daily - for 2 weeks
50mg daily - for 2 weeks
100mg daily after this
What conditions is lamotrigine used most for?
Chronic pain
Neuropathic pain
What are the side effects of lamotrigine?
Blurred vision GI Nausea Vomiting stevens johnson syndrome
What is the correlation between anticonvulsants and LFTs?
Can cause an increase in LFTs.
As long as the LFT doesn’t triple, its okay.
What is the role for lithium?
Its an adjuvant for antidepressants in unipolar depression
It acts as prophylaxis
