Mood stabilizers

Group of drugs principally used for the treatment of bipolar disorders → stabilize the mood → eliminate/reduce acute manic phases/act prophylactically to "stabilize" the mood

Principal mood stabilizers and their MoA[edit | edit source]

See pharmacology section for more details

First-line agent for long-term treatment of mania and its prophylaxis
- Lithium
  - MoA: Inhibition of the phosphoinositol cascade?, unclear
  - Steady state after 4-5 days (not acute treatment)
  - Besides bipolar disease: also augmentation in the treatment of depression
  - narrow therapeutic range
  - Cave:
    - Drug interactions: NSAIDs, hydrochlorothiazide -> reduce the GFR and can cause increased litihium levels
    - Side effects:
      - Nephrotoxicity (nephrogenic diabetes insipidus
      - Hypothyroidism
      - Teratogenic: can cause Ebstein anomaly (rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn't formed properly. As a result, blood leaks back through the valve and into the right atrium)
      - Acute intoxication: CNS (tremor, confusion), GI upset
- Valproic acid: In patients with bad renal function (i.e. increased creatinine levels)
- Others
  - Lamotrigine: especially useful for severe bipolar depression
  - Carbamazepine
- Antipsychotics: Quetiapine- can be given in combination with lithium or valproic acid in refractory cases