Mood is a pervasive & sustained emotion that colours the
person's perception of the world.
Mood Instability : Mood instability is rapid oscillations of
intense a fect with di ﬁculty in regulating these oscillations
or their behavioural consequences
Mood Instability is part of :
Borderline personality disorder
• Mood Stabilizer are Medicines used in treating
mood disorder such as bipolar disorder &
• Bipolar disorder is a type of mood disorder.
• Patient can be:
• Mania/ Hypomania
• Mixed aﬀective state
• ( Depressive+ Manic/ hypomanic symptoms)
4. Mood Stabilizer also know as
• antimanic drugs are used in the treatment of
mania both to control acute attack & to prevent
their recurrence for bipolar disorder.
6. • Lithium:
• Lithium ion (Li+) oldest & best known mood Stabilizing
• Lithium salts (carbonate, citrate) are most commonly
• 60-80% success in decreasing acute manic and hypomanic
• Decrease the risk of suicide related to bipolar disorder.
• Uses: - Prophylaxis & treatment of mania
• -Prophylaxis & maintenance treatment of bipolar disorder
• - Prophylaxis of recurrent depression in unipolar
depression & schizophrenic patients who don't respond to
7. • Lithium carbonate
• lithium is clinically effective at plasma concentration of
0.5-1mm, above 1mm it produces a variety of toxic effects so
monitoring of plasma concentration is essential.
• Lithium causes depletion of membrane phosphatidyl inositol &
accumulation of intracellular inositol phosphate
• Hormone mediated cAMP production is reduced.
8. Adverse eﬀects:
• Anorexia , Diarrhoea
• Renal A/E: Polydipsia, polyuria, Edema, nephrotic syndrome
• Cardiac A/E: sick sinus syndrome
• Enlargement of thyroid gland & Decrease function
• If used in pregnancy Lithium toxicity manifested by lethargy,
cyanosis poor suckling hepatomegaly.
• It has low risk of teratogenic effect.
9. Anticonvulsants mood Stabilizing
• Valproic acid
• Carbamazepine: as a mood Stabilizer it is superior
to Lithium for rapid cycling (bipolar)
• 2nd line treatment for mania
• DOC for Partial seizures & Tonic clinic seizures
10. • Carbamazepine Mechanism of action:
• Blockade of voltage dependent sodium channel
• ( deceased cell excitability , decrease neuronal ﬁring)
• Attenuates glutamates
• Side eﬀects:
• GIT upset
• suppression of bone marrow
• decrease eﬃcacy of other drugs e.g. OCP,Oral anticoagulants,
11. Valproic acid
• MOA- Blockade of sodium channel
• potentiation of GABA(increase synthesis)
• Block T type Ca++channels
• It is eﬀective in some patients who have failed to
respond to lithium.
• Prefered over lithium for initial therapy but
lithium is still preferred for maintenance
• Anticonvulsants drug used in treatment of
epilepsy & bipolar disorder.
• Lamotrigine acts as a mood Stabilizer. It is the 1st
medication since lithium to be granted approval
by U S. FDA for maintenance treatment.
• Most eﬀective in treatment & prophylaxis of
• MOA: Inhibition of voltage sensitive sodium
channel thereby Stabilizing neuronal membrane
consequently modulating presynaptic transmitter
release of excitatory amino acid
13. Side eﬀects: Life threatening skin
-Steven Johnson syndrome
-Toxic Epidermal Necrolysis
Lamotrigine bind to melanin containing
tissue such as iris of Eye.
14. Atypical Antipsychotics
• They having mood Stabilizing eﬀect & are thus commonly
prescribed even when psychotic symptoms obtained.
• Risperidone - approved for treatment of bipolar disorder.
• Olanzapine approved for acute mania with bipolar disorder
• Clozapine eﬀective but have potential serious side
• MOA : all antipsychotics drugs block D2 receptor in the brain
• atypical Antipsychotics exerts part of their action through
blocking of 5HT2A receptor
• Used in acute mania .
• Potentiate GABAnergic neurotransmission in CNS
• Diazepam extreme mood elevation
• give rapid sedation
• useful until the eﬀects of lithium takes place