Mood Stabilizers

Question 1

Lithium

Answer 1

Treat: acute mania, bipolar, schizoaffective, cyclothymia, unipolar depression
metabolized by kidney
onset takes 5-7 days
Initial Workup: ECG, basic chem, thyroid funtion, urine hCG, CBC
Blood level therapeutic 0.6-1.2 (>1.5 toxic, >2 lethal)
shown to decrease suicidality

Question 2

Side effects of Lithium

Answer 2

Toxicity - altered mental status, coarse tremors, convulsions, death
SE: fine tremor, GI, wt gain, sedation, thyroid dysfunction, benign leukocytosis, EKG changes
Rare: nephrogenic DI, Ebstein’s anomaly

Question 3

What affects lithium levels

Answer 3

NSAIDs (except ASA), dehydration, salt deprivation, impaired renal function, diuretics all increase lithium levels

Question 4

Carbamazepine

Answer 4

Tegretol
anticonvulsant
Treats: mixed episodes, rapid cycling bipolar, trigeminal neuralgia
blocks Na channels - inhibits action potential
onset 5-7 days
Initial workup: CBC, LFTs

Question 5

Side effects of Carbamazepine

Answer 5

GI, CNS (drowsiness, ataxia, sedation, confusion), leukopenia, aplastic anemia, thrombocytopenia
agranulocytosis
hyponatremia - SIADH
increased LFTs- hepatitis
Steven's Johnson Syndrome
Teratogenic - Neural tube defects

Question 6

Valproic Acid

Answer 6

Depakote, Depakane
Treats: mixed, rapid cycling bipolar
monitor LFTs, CBC
therapeutic drug level 50-150
Lamotrigene, Oxcarbazepine, Gabapentin, Pregabalin, Tiagabine, Topiramate
SE: GI, wt gain, sedation, alopecia, pancreatitis, hepatotoxicity, increased ammonia, thrombocytopenia, teratogenic

Question 7

Lamotrigene

Answer 7

Lamictal
Valproic Acid
blocks Na channels that mediate glutamate, aspartate
treats: bipolar depression, little efficacy for mania
SE: dizzy, sedating, h/a, ataxia, 10% SJS (most likely in first 4-6 wks)

Question 8

Oxcarbazepine

Answer 8

Trileptal
Better tolerated than carbamazepine
less risk of SJS, hepatitis

Question 9

Gabapentin

Answer 9

Neurontin
used adjunctively to help with sleep, anxiety
little efficacy in bipolar depression

Question 10

Pregabalin

Answer 10

Lyrica

treats: GAD, fibromyalgia

Question 11

Tiagabine

Answer 11

Gabitril

treats: anxiety

Question 12

Topiramate

Answer 12

Topamax
helps with impulse control d/o, anxiety
SE: wt loss, cognitive slowing, hypochloremic nongap metabolic acidosis, kidney stones

Question 13

Mood stabilizers treat:

Answer 13

acute mania, prevent mania in bipolar and schizoaffective d/o, potentiate antidepressants in refractory MDD, potentiate antipsychotics, enhance abstinence in alcohol treatment, treat aggression/impulsivity