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Mood stabilizers
This document outlines mood stabilizers, including lithium, valproate, carbamazepine, and antipsychotic agents. It discusses their pharmacologic actions, therapeutic indications, dosages, guidelines, and precautions. Mood stabilizers are used to treat bipolar disorder and other conditions by decreasing the frequency and severity of manic and depressive episodes. Key precautions include risks during pregnancy, adverse effects like weight gain and liver toxicity, and the need for monitoring. Mood stabilizers are an important treatment option for bipolar disorder but require awareness of safety considerations.
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Mood stabilizers
- 1. MOOD STABILIZERS BY: Nur Liyanabinti ABD Malek Supervisor: Prof Ramli
- 2. Outlines Pharmacologic actions Dosage andclinical guidelines Precautions and adverse reactions Therapeutic indications The examples
- 3. MOOD STABILISERS Lithium ValproateLamotrigineCarbamazepine Anti psychotic agent Others
- 4. Lithium ◦ Used forshort-term and prophylactic treatment of bipolar I disorder. ◦ Absorbed by GIT ◦ Does not bind to plasma proteins, not metabolized in liver ◦ ½ life: 20 hours, equilibrium: 5-7 d of regular intake ◦ Excretion: ◦ through kidney (decreased clearance in renal insufficiency & after delivery, ◦ increased in pregnancy BBB permits only slow passage of lithium (a single overdose of Li does not necessarily toxicity) Pharmacologic actions
- 5. Therapeutic indications ◦Bipolar 1disorder ◦Major depressive disorder ◦Schizoaffective disorder and schizophrenia Manic episodes : control acute mania and prevent relapse, slow onset of action and exerts its antimanic effect over 1 to 3 weeks Bipolar depression: effective in the treatment of depression associated with bipolar type 1 Maintenence : decreases the frequency, the severity and the duration of manic and depressive episodes. Effective against in the long treatment of major depressive disorder Not more effective than antidepressant drug Person with predominant mood symptom in schizoaffective are more likely react to Lithium rather than those with predominant psychotic symptom. As augmentation agent. As the treatment of choice for schizoaffective are dopamine receptor antagonist, serotonin- dopamine antagonist For schizophrenia patient that do not tolerate with anti- psychotic drug
- 6. Precaution and adverseeffect • Start with low dose firstElderly person • Don’t start Lithium in 1st trismester (Ebstein anomaly (20 x HR) Pregnant lady • Need to evaluate potential risk and benefit as lithium is excreted into breast milk Breastfeed mother
- 7. • Nausea, decreasedappetite, vomiting and diarrheaGIT • Lithium induce hypothyroidism, lithium induced edemaWeight gain • Tremor, cognitive effect (dysphoria, lack of spontaneousity, slowed reaction times and impaired memory) Neurological • Polyuria and polydipsia, Nonspecific interstitial fibrosis (10 years), renal failure, nephrotic syndrome Renal • Benign reversible exophthalmos, hyperthyroidism, hypothyroidismThyroid • ECG: resemble of hypokalemia, T- wave flattening or inversion • Sinus dysrhythmias, heart block and syncope. Cardiac • Dose dependent: acneiform, follicular and muculopapular eruption, pretibial ulceration, worsening psoriasis Dermatological
- 9. Dosage and clinicalguideline Baseline investigations • Renal profile • Thyroid function • Full blood count • ECG • Pregnancy test Serum & plasma concentrations of lithium • Every 2 to 6 months • Except : • Non- compliant • Toxicity • Dosage adjustment *1 to 1.5mEq/L in acute mania 0.4 to 0.8 mEq/L in maintenance Acute mania: 600 – 1800 mg/day in divided doses Maintenance dose: 300 – 1200 mg/day in divided doses (Desired serum level : 0.6 - 1.2 mEq/L not exceeding 1.5 mEq/L) To be used with caution and correlate clinically #CPG Bipolar disorder
- 10. Valproate ◦ More preferablethan lithium ◦ Epilim ◦ Also being used in treatment of seizure and migraine prophylaxis ◦ Absorbed 1 to 2 hours after oral administration, ◦ Plasma half life: 10 to 16 hours ◦ Highly protein bound ◦ Metabolized in liver Pharmacologic actions
- 11. Therapeutic indications Bipolar 1disorder Acute mania, mixed episodes, acute bipolar depression, prophylaxis Schizophrenia and schizoaffective (accelerate response to AP’s drug) Other mental disorder (alcohol withdrawal and relapse prevention, panic disorder, PTSD, impulse control disorder, behavioural agitation and dementia)
- 12. Precautions and adversereaction • Please avoid use it. May cause spina bifida (1st trimester)Pregnant lady • Not contraindicationBreastfeeding mother • Please avoid use itHepatic disease patient
- 13. • Hepatotoxicity (rarecause of death in patient older than 10 years old)Liver • Pancreatitis (rare)Pancreas • Thrombocytopenia, platelet dysfunctionHaematological • Nausea, vomiting, dyspepsia, diarrheaGIT • Tremor, sedation, ataxia, dysarthriaNervous • In long term treatmentWeight gain Hair loss
- 15. Dosage and clinicalguideline ◦ Acute Mania: 600 - 2500 mg/day in divided doses ◦ Maintenance dose: 400 - 2000 mg/day in divided doses ◦ (Desired serum level 50- 100 µg/mL @ 347-693 µmol/L) ◦ #CPG Bipolar disorder Baseline investigations • Liver function test • Serum amylase After 1 month of therapy • Full blood count • Liver function test • Pregnancy test
- 16. Carbamezapine ◦ Tegral ◦ Alsoused in partial and generalized onset epilepsy and trigeminal neuralgia. ◦ Absorption is slow and unpredictable ◦ Protein bound ◦ Metabolised in liver Pharmacologic actions
- 17. Therapeutic indications Bipolar disorder (acutemania, prophylaxis, acute depression) Other disorders (alcohol withdrawal)
- 18. • Nausea, vomiting,constipation, diarrhea, anorexiaGIT • sedation, ataxiaNervous Not cause weight gain • Blood dyscriasis (aplastic anemia, agranulocytosis)haematological • hepatitisLiver • Benign maculopapular rash, exfoliative dermatitis, erythema multiforme, steven Johnson syndrome, toxic epidermal necrolysis Dermatological Renal Cardiac effect • Hyponatremia, water intoxication • Exacerbate cardiac disease
- 20. Dosage and clinicalguideline ◦ Mania/mixed episodes ◦ 200 to 1600 mg/day in divided doses (Desired serum level 4-12 mg/L @ 1750 µmol/L) ◦ #CPG Bipolar disorder Laboratory monitoring Full blood count Liver function test Renal profile ECG
- 21. Antipsychotic: act asmood stabilizers ◦Olanzapine (can be used in maintenance phase) ◦Respiridone ◦Aripripazole ◦Quatiapine ◦Paliperidone ◦Asenapine
- 22. Other mood stabilizingagent ◦ Symbax (olanzapine and fluoxetine) ◦ Levitiracetam (keppra) ◦ Oxcarbazepine (trileptal)
- 23. Take home messages 1.Mood stabilizers is one of the treatment of bipolar disorder 2. Lithium and valproate are contraindication in pregnancy 3. Carbamezapine can cause steven Johnson syndrome 4. It is important to remember the side effect of the medication as it will alter the management.
- 24. References ◦ Kaplan &Saddock’ s pocket handbook of clinical psychiatrist ◦ CPG Management of Bipolar Disorder in Adults
- 25.