1. Mood Stabilizers
presented by.Dr.Neha Paikrao

2. Introduction:
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 :
Bipolar disorde
ADHD
Depressive disorders
Borderline personality disorder

3. Definition:
• Mood Stabilizer are Medicines used in treating
mood disorder such as bipolar disorder &
depression.
• Bipolar disorder is a type of mood disorder.
• Patient can be:
• Mania/ Hypomania
• Depression
• Mixed affective state
• ( Depressive+ Manic/ hypomanic symptoms)

4. Mood Stabilizer also know as
antimanic agents
• antimanic drugs are used in the treatment of
mania both to control acute attack & to prevent
their recurrence for bipolar disorder.

5. Mood Stabilizers
• 1. Lithium salt- Lithium carbonate
• 2.Anticonvulsants:
• - Carbamazepine
• -Valproic acid
• - Lamotrigine
• 3.Atypical antipsychotics
• - Olanzapine
• - Risperidone
• - Clozapine
• 4.benzodiazepines

6. • Lithium:
• Lithium ion (Li+) oldest & best known mood Stabilizing
drug
• Lithium salts (carbonate, citrate) are most commonly
prescribed.
• 60-80% success in decreasing acute manic and hypomanic
states.
• 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
• Hypothyroidism
• Seizures
• Leukocytosis
• 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
agents
• Carbamazepine
• Valproic acid
• Lamotrigine
• 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
• sedation
• ataxia
• suppression of bone marrow
• decrease efficacy of other drugs e.g. OCP,Oral anticoagulants,
warfarin

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
treatment.

12. Lamotrigine
• 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
bipolar depression.
• 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
reactions
-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
• effects.
• MOA : all antipsychotics drugs block D2 receptor in the brain
& periphery
• atypical Antipsychotics exerts part of their action through
blocking of 5HT2A receptor

15. Benzodizepines
• Used in acute mania .
• Potentiate GABAnergic neurotransmission in CNS
• Diazepam extreme mood elevation
• give rapid sedation
• useful until the effects of lithium takes place

16. • Thank you

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