Mood Stabilizers Flashcards
Lithium, overview
Naturally-occurring element
*Prescriptions Li= 1000X concentration
Typical dose in bipolar patients is 200 mg/day
Therapeutic usage of lithium first discovered by John Cade, in 1949
o But therapeutic effects have been noted prior
Healing springs – contain elevated levels of lithium
• Lithium-infused drinks, i.e. 7-Up
Lithium: Side effects
Blurred vision
Hair loss
Nausea
Weight gain
Tremors
Seizures
Slurred speech
Kidney failure
Lithium can produce hyper- or hypothyroidism.
*Initially, may cause GI complaints, but these decrease over time
Lithium: Predictors of positive response
Prior long-term positive response
Family members who have responded positively to the drug
Classic, pure, mania
Mania that is typically followed by depression
Lithium: Suicide Prevention
Lithium significantly reduces suicide rate
- 25-50% of all those diagnosed with bipolar disorder attempt suicide (highest rates of any mental disorder)
- 15% complete suicide
Lithium: Mechanism of Action
Theories:
Stabilize Na+ ion channels
Alters neural responding
Stimulates neural growth
Lithium: Contraindications / Interactions
Non-steroid, anti-inflammatory drugs increase lithium levels in the body
Lithium toxicity:
• Coma, kidney failure, delirium, death
Contraindication - pregnant women
*Can cause fetal abnormalities
Lithium: Response rates
50% success
- Lithium is not as effective in treating depressive episodes of bipolar disorder
- 70% of bipolar patients who are using lithium no longer experience switching
Lithium: Why not more commonly prescribed?`
Stigma: Associated with severe mental illness (SMI)
Low cost = low profits
Lack of proper monitoring can cause serious side effects
Physicians in the mid-90s used to prescribe lithium instead of NaCl for hypotension
• Excessive use leads to death
Depakote vs. Lithium
Similar effectiveness for treating mania as lithium
Also effectively treats BP depression (unlike lithium)
*but not unipolar depression
Better tolerated than lithium
Depakote: Mechanism of Action
Increases GABA activation and decreases Na+ ions
Modulates 5-HT and NE
Depakote: Side Effects
Weight gain
Nausea
Sedation
Hair Loss
Tremor
Transaminitis, or a liver enzyme dysfunction
Polycycstic ovaries
*Harmful to fetus and fertility–neural tube defect 2ndary to reduction in folic acid
“Depakote Loading”
Depakote is metabolized by the liver within 18 hours
Able to quickly increase levels within TWO DAYS in order to achieve therapeutic levels
Lamictal, general
Anticonvulsant
Effective tx of bipolar depressive episodes
*Also be used to treat chronic pain
Lamictal: Mechanism of Action
Theories:
Inhibition of Na+ channels
5-HT antagonism to increase DA and stabilize mood
Lamictal: SJ Syndrome
Lamictal increases risk of Stevens-Johnson syndrome, a lethal rash
Requires strict monitoring and slow titration
*especially when paired with Depakote
Lamictal can also cause non-lethal rashes
Discontinue immediately if any rash develops
*readminister after medical testing to rule out SJ
Lamictal: Side Effects
Biggest risk: SJ Syndrome
Nausea/vomiting
Sedation
Dizziness
Confusion
Ataxia
AP: Seroquel, general
Atypical AP commonly used to treat bipolar disorder
Popularly prescribed to those with schizoaffective disorder
Reduces suicidal ideation and suicide attempts by 50%
Anticonvulsants: Tegretol
Second line agent in bipolar disorder
*also used as adjunctive med for SZ
Indications:
- Acute Mania
- Mania prophylaxis
- Cyclothymia
- Mixed episodes
High side effects, drug-drug interactions, not very effective
Mood Stabilizers: Tests prior to treatment
Baseline liver function
CBC
EKG
Pregnancy
Depakote: Factors predicting a positive response
Rapid cycling patients (females>males)
Bipolar with mixed features
Comorbid substance issues
Comorbid anxiety disorders
Mood stabilizers: Classes
Lithium and Anticonvulsants
Selection is based on symptoms and sfx profile
Lithium: Potential Benefits
Increases density of gray matter
*Decreased risk of Alzheimer’s and dementia
Neurogenesis, promotes resilience of neurons, and protecting from stress effects
Mood stabilizers: Indications
Bipolar Disorder
Cyclothymia
Schizoaffective Disorder
Impulse control and intermittent explosive disorders
AP: Seroquel: Rapid Onset
Within 1 week Seroquel can:
- decrease core ax and dep sx
- improve QoL
- increase compliance rate of other medications
The “1 - 2 Punch” tx of Bipolar Disorder
Lithium combined with Lamictal
*No interaction effects
Lithim for mania
Lamictal for bipolar depression
Depakote: other indications
Anger
Social anxiety
