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Mood Stabilizers

Indications

Mood stabilizers are the drugs of choice for bipolar disorder, schizoaffective disorder, and cyclothymia.

They are effective for acute mania and for prophylaxis of mania and depression in bipolar disorders. Less effective for bipolar depression.

These agents are sometimes effective for impulse control disorders secondary to severe personality disorders, mental retardation and aggressive behavior seen in dementia.

Lithium (Eskalith, Eskalith CR, Lithonate)

It has been the mainstay of treatment of mania and bipolar disorder.

In addition to being an anti-manic agent, possesses modest but significant antidepressant properties. However is less effective than valproate (Depakote) in rapid cycling mania than in non-rapid cycling mania.

Regular and slow-release forms of carbonate are available and either form may be given twice daily initially switching to once daily dosing after several weeks.

Healthy young adults can usually tolerate 300-600 mg of carbonate, twice daily at the start of therapy. The dose is increased over seven to ten days until the plasma level is 0.80-1.20 mEq/L (0.80 to 1.20 mmol/L). Serum levels are measured 12 hours after the preceding dose of lithium.

Common side effects include polyuria, thirst, edema, weight gain, fine tremor, mild nausea (especially if the drug is not taken with food), and diarrhea.

Toxicity is manifest by coarse tremor, stupor, ataxia, seizures, persistent headache, vomiting, slurred speech, confusion, incontinence, and arrhythmias. Toxicity may occur when a patient becomes ill and ceases to eat and drink normally but continues to take as prescribed. A patient who cannot eat and drink normally should temporarily discontinue.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, and ACE inhibitors elevate the plasma level. levels should be carefully monitored. A reduction of dose may be required.

Levels rise 20-25 percent when diuretics such as chlorothiazide (Diuril) are initiated. A reduction of dose may be required.

Laboratory evaluation prior to beginning treatment with should include blood urea nitrogen, creatinine, electrolytes, fasting blood carbamazepine, Tegretol