Mood Stablisers

Question 1

What are mood stabilisers used for?

Answer 1

prevent depression, and mania in BPD and schizoaffective disorder

Question 2

What is the mechanism of action of Lithium?

Answer 2

sodium related action, lowering NAd release and increasing serotonin
*exact mechanism unknown
*significant evidence for reducing suicide and augments antidepressants

Question 3

Why is it vital to monitor lithium levels after starting?

Answer 3

*narrow therapeutic window - ie gap between effective and toxic dose
so 12h after first, weekly after dose change, until level stable then 3m once stable

Question 4

What other investigations need to be carried out when on lithium?

Answer 4

before - U&E, eGFR, TFT, pregnancy status baseline ECG

then U&E every 6m and TFT every 12m

Question 5

What are some side effects of lithium?

Answer 5

GI disturbance, metallic taste, dry mouth, fine tremor, polydipsia, polyuria, weight gain, ADH effects

Question 6

What are some long term effects of lithium?

Answer 6

hypothyroidism - usually reversible
renal impairment - usually irreversible (excreted by kidneys)

Question 7

What is lithium toxicity so dangerous? And how would you manage?

Answer 7

confusion, coarse tremor, nausea, vomiting, ataxia, seizures, coma and death
*enhanced by dehydration, drugs (ACEi and NSAIDs), diuretics and depletion of sodium as concentration increases

STOP lithium immediately, high fluid intake inc. IV sodium chloride to stimulate osmotic diuresis. renal dialysis maybe needed!

Question 8

What are some other mood stabilisers?

Answer 8

*anticonvulsants
Sodium valproate - teratogenic so not for children bearing age, check LFT before and soon after
Carbamazepine
Lamotrigine - stevens johnson syndrome

potential to cause thrombocytopenia so check FBC
may cause sedation and weight gain (less with Lamotrigine)

Question 9

What is newly first line for BPD?

Answer 9

Quetiapine!