Mood stabilizers

Question 1

Class: Mood stabilizer.
Indications:

Primarily used for the treatment of bipolar disorder, particularly for managing manic episodes and as maintenance therapy to prevent mood swings.
Also used as an adjunct in major depressive disorder (MDD) and to reduce the risk of suicide in individuals with mood disorders.

Mechanism of Action:

The exact mechanism is not fully understood, but lithium is thought to stabilize mood by modulating neurotransmitter signaling (e.g., enhancing serotonergic activity) and influencing intracellular signaling pathways.

Side Effects:

Common: Tremor, polyuria (increased urination), weight gain, gastrointestinal upset, hypothyroidism.
Serious: Lithium toxicity, which can manifest as confusion, ataxia, severe tremor, seizures, and renal dysfunction.
Long-term use may lead to renal impairment and thyroid dysfunction.

Answer 1

Lithium

Question 2

Class: Anticonvulsant, mood stabilizer.
Indications:

Bipolar disorder (especially effective for rapid cycling and mixed episodes).
Seizure disorders (epilepsy) and as a preventive treatment for migraine headaches.

Mechanism of Action:

Increases levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, and blocks voltage-gated sodium channels, stabilizing neuronal activity.

Side Effects:

Serious: Steven Johnson’s Syndrome

Common: Weight gain, tremor, hair loss, gastrointestinal issues (nausea, vomiting), sedation.
Serious: Hepatotoxicity, pancreatitis, thrombocytopenia, and teratogenicity (birth defects).
Risk of polycystic ovarian syndrome (PCOS) in females, especially younger women.

Answer 2

Valproic Acid (Depakene)

Question 3

Class: Anticonvulsant, mood stabilizer.
Indications:

Bipolar disorder, particularly in cases of mania and mixed episodes.
Seizure disorders (epilepsy) and trigeminal neuralgia (a type of nerve pain).

Mechanism of Action:

Blocks voltage-gated sodium channels, reducing the firing of neurons and stabilizing mood.

Side Effects:

Common: Drowsiness, dizziness, ataxia, nausea, and rash.
Serious: Aplastic anemia, agranulocytosis (low white blood cell count), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), especially in individuals with certain HLA-B alleles (e.g., HLA-B*1502).
Hepatotoxicity and hyponatremia (low sodium levels).

Answer 3

Carbamazepine (Tegretol)

Question 4

Class: Anticonvulsant, mood stabilizer.
Indications:

Bipolar disorder, particularly effective for preventing depressive episodes in bipolar I disorder.
Also used in the treatment of seizure disorders.

Mechanism of Action:

Inhibits voltage-gated sodium channels, reducing excitatory neurotransmitter release (e.g., glutamate), and stabilizing mood.

Side Effects:

Common: Headache, dizziness, double vision, insomnia, and nausea.
Serious: Risk of serious skin reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The risk can be reduced by slow titration of the dose.
Less sedating compared to other mood stabilizers, and typically has fewer metabolic side effects.

Answer 4

Lamotrigine (Lamictal)