Mood Stabilizers

Question 1

Mood Stabilizers

Answer 1

Typically for bipolar disorder.
Also used for seizures, except lithium
Lithium is the gold standard
Often for borderline and some other personality disorders & violence

Question 2

lithium

Answer 2

Gold standard
both acute and maintenance
decrease risk of suicide, along with ECT and clozapine
side effects: low therapeutic index, black box warning for toxicity, has a level 0.5 - 1, hear defect in pregnancy, kidney and thyroid dz

Question 3

Valproic acid / divalproex

Answer 3

Depakote
Acute and no maintenance, but common
BB warning - liver, pacreas, neural tube defects, blood d/o’s, sedation, wt gain, hair loss
level 45-125
Used fairly commonly, but also has many side effects on different organs in the body and need to have lab monitoring.

Question 4

lamotrigine

Answer 4

Lamictal
maintenance only
Used mainly for the depressive phase of bipolar disorder. Approved by w/d studies
Black box warning: deadly skin reaction, slow increase , restart off >5d

Question 5

carbamazepine

Answer 5

Tegretol
More side effects and used less
Acute, but no maintenance 
Black box warnings: blood disorders, serious skin rxn - Asian HLA-B*1502 gene 
Induces liver enzymes and own/OCPs
Level 6 - 12 difficult

Question 6

oxcarbazepine

Answer 6

Trileptal
Similar to carbamazepine- chemical cousin
gentler and less enzyme/side effects
No bipolar indication, used less
Company pled guilty to off-label marketing
serious skin rxn - Asian HLBA-B*1502 gene
No level
More side effects and used less.