Mood Stabilizers Flashcards
What is a mood stabilizer
Effective in treating acute mania and depression
Effective in preventing recurrence of mania and de[ression
Effective in the extended treatment of mania and depression without worsening the other pole of the illness.
Three classes of mood stabilizers
Lithium
Anticonvulsants
Antipsychotics
Therapeutic use of lithium
Used to stabilize acute mania, used for maintenance treatment.
Lithium effect on neurotransmitter systems
Modulates the balance between excitatory and inhibitory neurotransmission. Acts at dopamine, 5HT (increases transmission)
Lithium effect on second messenger systems
Changes cAMP levels, changes phosphatidylinositol levels, down regulates PKC
Neuroprotective effect of lithium
Increases resilience of neurons by preventing cell death. Inactivates NMDA receptors to prevent excitotoxicity.
Metabolism of lithium
Not metabolized. Filtered at glomerulus and reabsorbed by proximal tubule. Mostly excreted in urine (95%).
How is lithium excreted?
Competes with Na for absorption. Lots of drugs decrease excretion like NSAIDS and Lasix.
Side effects of lithium on kidney
Neprogenic diabetes insipidus. Can also lead to glomerulopathy causing nephrotic syndrome.
How does lithium affect ADH?
Decreases, so patient is unable to concentrate urine well.
Other side effects of lithium
tremor, n/v, hypothyroidism, t wave flattening.
Dosing of lithium
Very narrow therapeutic index, can get toxic quickly. Can lead to irreversible kidney damage.
Anticonvulsants used in bipolar disorder
Valproate - mania and maintenance, rapid cycling
Carbamazepine- ‘’ ‘’ ‘’ ‘’
Lamotrigine- maintenance and depression, rapid cycling
How do anticonvulsants affect the sodium channel?
Stabilize inactive form. Also enhance gaba function.
Valproate effect on liver
Potent inhibitor of both oxidation and glucuronidation.
