Transcript Mood Stabilizers

Mood Stabilizers
By Claire Dibben
What are Mood Stabilizers?
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Lithium
Sodium Valproate
Carbamazepine
Lamotrigine
Others eg Topiramate
?atypical antipsychotics
Treats one of both poles of an illness without
causing a switch to the other pole
Confusion…
• Should it only be used for drugs that treat
both poles?
• Efficacy of drugs often clearer for one pole
than other
• Does it refer to acute or maintenance
treatment?
• Easier to refer to anti-manic/antidepressant
properties of drug
Lithium
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Alkali metal element
Mechanism of action only partly understood:
Effects on cation transport
Monoaminergic neurotransmission
Cholinergic neurotransmission
Effects on second messengers
Neuroprotective Effects
Excreted unchanged by the kidney
Sodium Valproate
• Available in different formulations eg
Depakote
• Most widely used mood stabilizer in USA
• Complex mode of action
• Mainly enhances GABA and strengthens
inhibitory circuits in CNS
Carbamzepine
• Has effects on ion channels, BDZs receptors
and GABA and adensoine receptors
Patient Information Leaflets
• Indications
• How take medicine/dosage/discontinuation
etc
• Drug Interactions
• Side effects
• Monitoring
• Pregnancy
• Driving
Lithium
• Mrs Smith has come to see you in outpatients.
She has a history of bipolar affective disorder
and wants to find out more about starting
lithium. She has researched it on the internet.
Explain Lithium treatment and answer any
questions that she may have.
Lithium Toxicity
• You are the doctor on call one night when the
A and E registrar calls you for advice.
• He has a 40 year old lady who has taken a
suspected overdose of her lithium tablets and
her lithium level has come back as 2.6. He
wants to know what to do next.
Lamotrigene
• Stabilizes neuronal membranes and reduces
release of excitatory amino acids
• Lacks anti-manic efficacy
• Useful anti-depressant in bipolar depression
as mono-therapy
• Can cause Stevens-Johnson syndrome
• Metabolism is inhibited by sodium valproate,
so slower does titration needed.