What are the 3 classes of mood stabilisers?
Lithium
anticonvulsants
antipsychotics
What conditions can mood stabilisers treat?
Bipolar, cyclothma, schizoaffective
What medication is shown to reduce suicide rate?
Lithium
Lithium is effect in?
long-term prophylaxis of both mania and depressive episodes
What factors predict a positive response to lithium?
prior long-term response
- family member with good response
- classic pure mania
- mania is followed by depression
What do you need to do before starting lithium?
- get baseline U&E and TSH (can affect renal function and thyroid - hypo)
- pregnancy tests
Lithium use in pregnancy is associated with which anomaly?
Ebstein’s - heart defect
How to monitor lithium use?
start at 400mg - check again after 5-7 days
- check 12 hours after last dose
- once stable check blood levels every 3 months (thyroid level)
- TSH and creatine after 6 months
Ideal blood level for using lithium?
0.6-1.2
Lithium side effects?
GI distress - nausea, vomiting, diarrhoea
- thyroid abnormalities
- non-significant leukocytosis
- polyuria/polydipsia secondary to ADH (can get intestinal renal fibrosis)
- hair loss, acne
- reduce seizure threshold, intention tremor!!
Lithium toxicity = mild, moderate and severe level and symptoms
mild = 1.5-2 = vomiting, ataxia, slurred speech, nystagmus
Moderate = 2-2.5 - anorexia, blurred vison, clonic limb movements, convulsions, delirium
Severe - >2.5
- generalised convulsions, oliguria and renal failure
Example of an anticonvulsant?
Valproic acid
- good for mania but not so much for depression
What factors contribute to a positive response using valproic acid?
- rapid cycling patients F>M
- comorbid substance issues (Alcohol)
- mixed patients
- patients with co-morbid anxiety disorders
Why do we tend to avoid lithium in those who consume alcohol?
can lead to dehydration due to toxicity
Tests before Valproic acid?
baseline LFTS
- pregnancy test
- FBC
Why do we avoid Valproic acid in pregnancy?
neural tube defects
How do we monitor valproic acid?
steady stage achieved after 4-5 days
- check 12 hours after last dose
- repat CBC and lfts
target goal of valproic acid?
50-125
Valproic side effects?
- thrombocytopenia and platelet dysfunction
- nausea, vomiting
- sedation , tremor
- increased risk of NTD - reduction of folic acid
- hair loss
What is the first line agent for acute mania and mania prophylaxis?
- who is it indicated for?
Carbamazepine
- rapid cyclers and mixed patients
Tests before starting Carbamazepine?
LFTS, FBC, ecg
how do we monitor Carbamazepine?
5 days steady state- 12 ours after last dose- repeat CBC + LFTS
Target levels for Carbamazepine?
4-12 mcg/ml
Carbamazepine side effects?
RASH
- cause, vomiting, diarrhoea, sedation, ataxia
