Mood stabilizer

Question 1

Treatment options

Answer 1

• lithium
• anticonvulsants
• antipsychotics
• benzodiazepines
• antidepressants

Question 2

Lithium

Answer 2

• First line of treatment
• Acute and relapse prevention
• Narrow therapeutic window
• Serum litium concentration
  > acute phase: 0.6-1.2 mol/l
  > Maintenance therapy: 0.4-0.8mmol/L
• Adverse effects within the therapeutic range are common
  > tremor
  > Hypothryioidism
  > Weight gain
  > sedation

Question 3

Anticonvulsants

Answer 3

• Valproic acid, divalproex sodium, sodium valproate = can be very irritating to the stomach. Liver function and complete blood count (CBC) should be monitored.
• Carbamazepine: CBC should be monitored, as carbamazepine can lower white blood cell count. Therapeutic drug monitoring is required.
• Lamotrigine = particularly effective for bipolar depression.

Question 4

Antipsychotics (SGA)

Answer 4

• For people who don’t respond to lithium and anticonvulsants

- Acute and maintenance treatment
> aripiprazole (abilify)
> olanzapine (zyprexa)
> risperidone (risperdal)
> Quetiapine (seroquel)
> asanapine (saphris)