Mood stabilizers

Question 1

Lithium

Answer 1

Use: Bipolar mania, bipolar depression, MDD

Start 300 BID-TID, max 1200mg

Side effects
- CBC w/diff, CMP, TSH/T4, preg, ekg
- NO NSAIDS or ACD inhibitors
- Avoid for outdoor workers
- Serotonin syndrome: confusion, agitation, headache, fever, hypertonia, sweating, tachycardia, VS instability

Question 2

Carbamazepine/Tegretol

Answer 2

Use: Seizures, pain r/t trigeminal neuralgia, acute mania/mixed mania, bipolar depression maintenance, psychosis, schizophrenia (adjunct)
- Dos increase later- metabolizes self

Start 200mg bid, max 1600 mg
-Tabs in 200; chewables in 100, solution in 100/5ml

Side effects
- “dirty drug” try not to use
- CBC, LFT, serum level (pancreas, liver)
- Renal/hepatic caution
- Taper
- GI, steven johnson, sedation, dizziness, SIADH, aplastic anemia, agranulocytosis (Asians- need HLA-B)

Question 3

Valproate/Depakote

Answer 3

Use- Acute mania/bipolar, maintenance bipolar, psychosis, schizophrenia adjunct
- Helps with aggression, agitation, impulse control
- Propranolol help with tremor

Start 250 am/500 hs, max 1500
- Delayed release tabs in 125, 250, 500
- Extended released tabs in 250, 500
- delayed release to extended release= 1000->1250
- ER to DR= 1000->750

Side effects
- CBC, LFT’s, INR, labs after 5 days (ammonia levels if liver concerns) therapeutic 50-125
- avoid in pregnancy
- take w/food
- Caution with lamictal, ASA may increase level
- GI, weight gain, fatigue, hepatotoxicity, malaise, weakness, lethargy, facial edema, vomiting, yellowing
- pancreatitis, abdominal pain, nausea, vomiting, anorexia

• More effective for rapid cycling/mixed states than lithium

Question 4

Lamotrigine/Lamictal

Answer 4

Use: Maintenance bipolar 1, bipolar depression, psychosis adjunct, MDD adjunct

Start 25mg x2 weeks, 50mg x 2 weeks, then 100mg x1 week, max 100mg
-Tabs in 25, 100, 150, 200

Side effects
- Steven Johnsons, Depakote, birth control effect dosing
-Caution with hepatic significant renal impairment

Question 5

Topiramate/Topamax

Answer 5

Use: Seizures, migraines, wt managment, bipolar, binge eating, psychotropic weight gain, bipolar
- lower dose for weight control
- very low efficacy in bipolar control

Start 25mg nightly, max 400 mg
- Tabs 50, 100, 200
- Caps in 15, 25

Side effects
- Baseline and periodic bicarb
- 1/2 dose for renal impairment
- sedation, dizzy, ataxia, paresthesia, nervousness, nystagmus, tremor, GI, weight loss, metabolic acidosis
- Life threatening if have kidney stones or glaucoma

Question 6

Oxcarbazepine/Trileptal

Answer 6

Use: Seizures, bipolar

Start 200mg BID, max 1600mg
- Tabs in 200,
- Chewables in 100
- Solutions in 100mg/5mL

Side effects
- Take with food nightly
- Nausea and vomiting, steven johnson, sedation, dizziness, SIADH, agranulocytosis, carefull with combined SSRI’s
- Monitor sodium
- Taper off