Mood Stabilizers

Question 1

Divalproex

Answer 1

Long safety profile on young kids

Question 2

Lithium

Answer 2

Mechanism of Action: inhibits adenylate cyclase enzyme

Half Life: 24hr

Side Effects: nausea, tremor, HYPOTHYROIDISM, cardiac dysrhythmias, diarrhea, DIABETES INSIPIDUS, thirst, urination, weight gain, acne, at toxic levels: alterations in consciousness, seizures, coma, death

Testing: WBC, serum electrolyte, thyroid and renal function tests (specific gravity, BUN, creatinine), fasting blood glucose, pregnancy test, ECG before treatment and yearly. TSH and creatinine every 6mo. Lithium levels monitored every 3mo once patient stabilized.

Comments: propranolol may help with tremor; benign increase in WBC count seen

Question 3

Valproic Acid, valproate (Depakene)

Answer 3

Mechanism of Action: opens chloride channels

Half Life: 8hr

Side Effects: thrombocytopenia, pancreatitis, weight gain, hair loss, GI distress, cognitive dulling, NEURAL TUBE DEFECTS in pregnancy

Testing: CBC, LFTs, pancreatic enzyme levels, serum hCG in childbearing women

Question 4

Carbamazepine (Tegretol)

Answer 4

Mechanism of Action: inhibits kindling, inhibits repetitive firing of APs by inactivating sodium channels

Half Life: 18-55hr

Side Effects: nausea, vomiting, slurred speech, dizziness, drowsiness, low WBC count, high LFTs, cognitive slowing, may cause CRANIOFACIAL DEFECTS in newborn

Testing: pretreatment CBC to assess for agranulocytosis. CBC draw every 2 weeks for first 2mo, then every 3 mo. platelet, reticulocyte, and serum iron levels yearly. LFTs initiallt, every month for first 2 months, then every 3 mo. Carbamazepine levels should be monintored. Serum electrolytes and ECG before treatment and yearly.

Comments: potent inducer of P450 system

Question 5

Lamotrigine (Lamictal)

Answer 5

Half Life: 15hr

Side Effects: leukopenia, rash, hepatic failure, nausea, vomiting, diarrhea, somnolence, dizziness

Testing: CBC with platelet count every 6-12mo

Comments: alternative choice, may have acute antidepressant effect; dose must be increased slowly to avoid rash

Question 6

Gabapentin (Neurontin)

Answer 6

Half Life: 5-9hr

Side Effects: somnolence, dizziness, ataxia, fatigue, leukopenia, weight gain

Testing: rash can be fatal