Mood Stabilizers

Question 1

valproate (valproic acid)

Answer 1

1. MOA is unknown.
   a. thought to change sensitivity of VSCCs by binding directly.
   b. thought to increase GABA through increase release and decrease reuptake or slowing activation.
   c. thought to influence downstream signal transduction cascades.
2. Linked to neuronal tube defects, pancreatitis, liver problems, thombocytopenia
3. Inhibits metabolism of lamotrigine; so use HALF lamotrigine.
4. Approved for the acute manic phase of bipolar.
5. Used long term to prevent recurrence of mania.

Question 2

Carbamazepine (Tegretol; Equetro)

Answer 2

MOA- Thought to block VSCCs at a-subunit.

1. It is a STRONG CYPA4 inducer because it interactions with A LOT of meds.
2. Induces its own metabolism (autoinduction).
3. Lowers levels of lamotrigine.
4. DO NOT PRESCRIBE WITH lurasidone, quetiapine, clozapine, long acting injectable formulations of aripiprazole, risperidone, or paliperidone.
5. Asian descent- high risk for Stevens-Johnson syndrome (10x risk)
6. Inhibition of CYP450 3A4 causes toxicity (autoinduction)

Question 3

Lamotrigine (Lamictal)

Answer 3

1. MOA- binds to open channel conformation of VSSCs (like carbamazepine).
2. fewer health risks and fewer side effects.
3. A high dose can shorten QC interval.
4. Avoid: digoxin, rufinamide, magnesium.
5. CYP450 enzymes are not involved.
6. If using carbamazepine , dilantin, phenobarbital, or primidone, then INCREASE lamotrigine by 50% because these medications DECREASE the blood levels of lamotrigine.

Question 4

Lurasidone (Latuda)

Answer 4

1. blocks 5HT2a, 5HT7, and a2 receptors
2. agonist actions at 5HT1a receptors
3. prescribed for bipolar depression and for mixed features

Question 5

Cariprazine (Vraylar)

Answer 5

1. D3, D2, 5HT1a partial agonist.
2. a1 and a2 antagonist actions.
3. highly potent action at D3 dopamine receptors as a partial agonist.
4. approved for treatment of acute bipolar mania and bipolar depression

Question 6

Anticonvulsants as Mood Stabilizers

Answer 6

1. Theory that mania may kindle further episodes of mania.
2. Mania-minded (treat from above and stabilize from above).
3. Depression-minded (treat from below and stabilize from below).

Question 7

Anticonvulsants NOT to use with bipolar

Answer 7

1. ozyxecarbazepine
2. eslicarbazepin (s-enantiomer)
3. topiramate- used for migraines
4. gabapentin and pregablalin- little to no action as mood stabilizer