Mood Stabilizers

Question 1

What are mood stabilizers used for?

Answer 1

To treat acute mania and to help prevent relapses of manic episodes in bipolar disorder and schizoaffective disorder. Less commonly they may be used for:

• Potentiation of antidepressants in patient with major depression refractory to monotherapy
• Potentiation of antipsychotics in patients with schizophrenia
• Enhancement of abstinence in treatment of alcoholism
• Treatment of aggression and impulsivity (dementia, intoxication, mental retardation, personality disorders, general medical conditions)

Question 2

What are the common mood stabilizers?

Answer 2

Lithium and anticonvulsants, most commonly valproic acid, lamotrigine and carbamazepine

Question 3

What may be used as adjuncts to mood stabilizers early in the course of a manic episode?

Answer 3

Antipsychotics

Question 4

What is the only mood stabilizer shown to reduce suicidality?

Answer 4

Lithium

Question 5

Blood levels are useful for what psychotropic drugs?

Answer 5

Lithium, Valproic acid, Carbamazepine, and Clozapine

Question 6

What should you think twice before prescribing to a patient on lithium?

Answer 6

Ibuprofen

Question 7

What is Lithium used for?

Answer 7

• Drug of choice for acute mania and as prophylaxis for both manic and depressive episodes in bipolar and schizoaffective disorders.
• Also used in cyclothymia and unipolar depression

Question 8

How is Lithium metabolized?

Answer 8

By the kidney. So you have to adjust the dose and monitor levels closely if patient has renal dysfunction.

Question 9

What tests do patients need prior to starting Lithium?

Answer 9

Patient should have ECG, basic chemistries, thyroid function tests, a complete blood count, and a pregnancy test

Question 10

What is the onset of action for Lithium?

Answer 10

5-7 days

Question 11

How often should blood levels be checked with Lithium?

Answer 11

Blood levels correlate with clinical efficacy. Should be checked after 5 days and then every 2-3 days until therapeutic.

Question 12

What is the major drawback of Lithium?

Answer 12

Its high incidence of side effects and very narrow therapeutic range.

Question 13

What is the therapeutic, toxic and lethal ranges for Lithium?

Answer 13

Therapeutic range is 0.6 to 1.2 (individual patients can become toxic even within this range). Toxic greater than 1.5. Lethal greater than 2.0.

Question 14

What factors affect Lithium levels?

Answer 14

NSAIDS (dec), Aspirin, Dehydration (inc), Salt deprivation (inc), Sweating (salt loss - inc), Impaired renal function (inc), Diuretics, esp. thiazides

Question 15

What can toxic levels of lithium cause?

Answer 15

Altered mental status, coarse tremors, convulsions and death.

Question 16

What must clinicians monitor in patients on lithium?

Answer 16

Blood levels of lithium, thyroid function (thyroid-stimulating hormone), and kidney function.

Question 17

What are the side effects of Lithium?

Answer 17

Fine tremor, Nephrogenic diabetes insipidus, GI disturbance, weight gain, sedation, thyroid enlargement, hypothyroidism, ECG changes, benign leukocytosis

Question 18

What birth defect can Lithium cause?

Answer 18

Epstein’s anomaly, a cardiac defect in babies born to mothers taking lithium.