MOOD-STABILIZING AGENTS
Four mood stabilizers in common use: lithium, valproic acid, carbamazepine/oxcarbazepine, and lamotrigine (Table 200-4). Lithium is the gold standard and the best studied, and along with carbamazepine and valproic acid, is used for treatment of acute manic episodes; 1–2 weeks to reach full effect. As prophylaxis, the mood stabilizers reduce frequency and severity of both manic and depressed episodes in cyclical mood disorders. In refractory bipolar disorder, combinations of mood stabilizers may be beneficial.
AGENT AND DOSING | SIDE EFFECTS AND OTHER EFFECTS |
---|---|
Lithium | Common Side Effects |
Starting dose: 300 mg bid or tid Therapeutic blood level: 0.8–1.2 meq/L | Nausea/anorexia/diarrhea, fine tremor, thirst, polyuria, fatigue, weight gain, acne, folliculitis, neutrophilia, hypothyroidism Blood level is increased by thiazides, tetracyclines, and NSAIDs Blood level is decreased by bronchodilators, verapamil, and carbonic anhydrase inhibitors Rare side effects: Neurotoxicity, renal toxicity, hypercalcemia, ECG changes |
Valproic Acid | Common Side Effects |
Starting dose: 250 mg tid Therapeutic blood level: 50–125 µg/mL | Nausea/anorexia, weight gain, sedation, tremor, rash, alopecia Inhibits hepatic metabolism of other medications Rare side effects: Pancreatitis, hepatotoxicity, Stevens-Johnson syndrome |
Carbamazepine/Oxcarbazepine | Common Side Effects |
Starting dose: 200 mg bid for carbamazepine, 150 mg bid for oxcarbazepine Therapeutic blood level: 4–12 µg/mL for carbamazepine | Nausea/anorexia, sedation, rash, dizziness/ataxia Carbamazepine, but not oxcarbazepine, induces hepatic metabolism of other medications Rare side effects: Hyponatremia, agranulocytosis, Stevens-Johnson syndrome |
Lamotrigine | Common Side Effects |
Starting dose: 25 mg/d | Rash, dizziness, headache, tremor, sedation, nausea Rare side effect: Stevens-Johnson syndrome |
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