Mood Stabilizers Group 3

MOOD STABILIZERS
GROUP 3 PARTICIPANTS
1. Martha konga
2. Faraja chanafi
3. Erick chilongola
4. Joffrey garrison
Outline
• Introduction
• Classification
• Mechanism of action
• Side effects
• Non pharmacological mood stabilization
• References.
Introduction
• Mood is pervasive and sustained feeling tone that is endured internally and which impacts nearly
all aspects of person’s behavior in the external world.
• Affect is the patient’s present emotional responsiveness
• Mood disorders are described by marked disruption in emotion ( severe lows called depression and
highs called hypomania or mania). These are common psychiatric disorders leading to an increase
in morbidity and mortality.
• Mood instability is the rapid change in low and high mood and also anxiety and irritability
• Mood instability can be seen in patients with bipolar disorders, depressive disorders and borderline
personality disorders .
Introduction…
• Mood stabilizers are medications used to treat patients with bipolar disorders.
These medications help to prevent manic episodes and can help prevent
depression. Mood stabilizers are triple threats meaning they are antimanic,
antidepressant and prophylactic
• The cause of bipolar disorders is not well understood and the drugs used to treat it
are still not well understood.
Classification of Mood stabilizers
• lithium
• Anticonvulsants eg; Carbamezapine and Valproic acid (Sodium valproate)
• Antipsychotics (both first and second generation)
• ECT (electroconvulsive therapy)
Drugs regimen in Bipolar 1 and 2
BIPOLAR 1 BIPOLAR 2
• Mood stabilizer and • Antipsychotics, mood stabilizer
antipsychotics, because most and anti depressant, because they
times they do present with do present predominantly with
predominantly Manic episodes, depressive episodes than manic
with less depressive episodes. episodes.
1. Valproic acid (Sodium valproate) and
dosage
• It is used to treat bipolar disorder, occasionally used to prevent migraine and
can be used to treat convulsions.
• Mechanism of action: Its mechanism of action is poorly understood, postulated
mechanism include blocking (modulation) sodium channels which reduces
neuron activity and it also it increases activity of GABA.
• Its usually available in form of 200 mg, 250mg, and 500mg tablets, given
according to severity of the client's symptoms.Its usually given BD/12 hrly for a
long period of time, and tapered down slowly as symptoms disappear.
Maximum dose is 1000mg per day.
Side effects of sodium valporate
• Teratogenicity (neural tube defects). So, for pregnant women, folic acid supplementation is
mandatory.
• GI effects (nausea, diarrhoea)
• Visual problems e.g. double vision and lazy eye.
• Hormonal disturbances, e.g. increased testosterone in women, hair loss, &menstrual disturbances.
• Weight gain.
• Low red, and white blood cells, and platelets.
• It may also cause hepatitis, and pancreatitis.
• Hyperammonemia moe common in combination with carbamazepine
What to consider before administering
sodium valporate
Before starting the medication, do pregnancy test and routine bloodwork
followed by these routine investigations every 6 months;
• CBC (complete blood count); since it may cause low red blood cells, low
white blood cells, and low blood platelets.
• Liver Function Test (LFT); ALT and AST to check for liver inflammation,
as it may cause hepatitis.
• Lipase blood test; it can cause pancreas inflammation, especially if the
patient is presenting with abdominal pain as a sign pancreatitis.
Valproic acid toxicity
• Sleepiness (somnolence)
• Low blood Pressure (hypotension)
• Low respiratory rate (bradypnea)
• Seizures
• Low blood count on CBC blood test.
2. Carbamazepine
• Is an anticonvulsant drug used primarily to treat epilepsy and neuropathic
pain. Its an adjunctive treatment for schizophrenia along with other
medications and an agent for bipolar disorder.
• Mechanism of action; Acts by binding to voltage-dependent sodium
channels in the inactive state and thus prolonging their inactivation, thus
reducing synaptic transmission.
Dosage for Carbamazepine
• Its usually available as a one tablet of 200mg.
• It can be given OD/BD depending on severity of symptoms.
• Maximum dose being 600 mg per day.
• When given with benzyhexol or aminoglycosides or any other drugs
which lower their therapeutic levels maximum dose can be raised to 800
mg.
Side effects of carbamazepine
• Lethargy
• Tremors (rhythmic, rapid, symmetrical, most prominent in upper extremities, and may
respond to dose change, also may be treated with propranolol)
• Teratogenicity; harmful to fetus as it can also cause neuro-tube defects(slight risk). Its safer
than valproic acid, but less safe than Lithium.
• Steven-Johnson syndrome is rare but can be deadly.
• GI (nausea and diarrhea)
• Aplastic anemia and agranulocytosis
• Neurologic; Dysarthria, ataxia, incoordination, diplopia, & Nystagmus.
What to consider when using Carbamazepine
• Before starting medication, perform pregnancy test, Complete blood count

and Liver function test.
• Then, after starting dose, perform Complete blood count(CBC), ALT to
check for liver inflammation every after 6 months.
• If a patient presents with steven Johnson syndrome, change to sodium
valproate immediately.
3. LAMOTRIGINE
• It was developed as an anti-convulsant, but was later shown to be effective as a maintenance
treatment for bipolar disorders.
• Mechanism of Action: It blocks voltage-sensitive sodium channels, also modulates the release of glutamate
and aspartate. It also modestly increases plasma serotonin concentrations by preventing its reuptake.
• It is available in 25,100 and 200mg tablets. In Bipolar disorder it can be given once daily (OD) between
100 – 200mg daily.
• Lamotrigine has significant drug interaction with other drugs, the most serious interaction is with valproic
acid, in which when used concurrently, the serum levels of lamotrigine are doubled.
• When used concurrently with carbamazepine, phenytoin or phenobarbital its concetration is decreased by
40 to 50 percent.
SIDE EFFECTS
Lamotrigine is well tolerated. The most common adverse effects include
• Dizziness
• Ataxia
• Somnolence
• CNS manifestation ( headache,diplopia, blurred vision)
• Rash, which is common and occasionally severe and is a source of concern and
drug should be stopped immediately since they can be a early manifestation of
Stevens – Johnson syndrome
3. Lithium Carbonate
• It is also a prescription medicine used to treat the symptoms of Bipolar
disorder. It belongs to class of drugs called Bipolar Disorder Agents.
• It is not used in our setting.
• How it works; It works by increasing GABA, an inhibitory
neurotransmitter.
DRUG INTERACTIONS
• Thiazides diuretics and ACE inhibitors reduce the renal clearances of

lithium and should be avoided if possible.
• NSAIDs can also prevent the excretion of lithium leading to lithium
toxicity.
Lithium carbonate effects
• Teratogenic. It is harmful to fetus, although less riskier in pregnancy than sodium
valproate, and carbamazepine. It may rarely cause ebstein’s anomaly (1 in 100 births).
• Metallic taste in the mouth
• Tremor
• Polyuria/polydipsia
• Weight gain
• Hypothyroidism
• ECG changes like that of hypokalemia
Lithium toxicity (levels above 1.5mmol/L)
• Severe GI symtopms (Nausea, vomiting, and diarrhea)
• Tremors and muscle twitching
• Ataxia
• Dyarthria (abnormal speaking)
• Seizures
• Coma
What to consider in using Lithium carbonate.
• Perform pregnancy test before start of dosage.

• EKG is to be performed before starting Lithium and as prn(as per needed)
• Then perform these tests every 6 months; Electrolytes levels, renal
function test(creatinine levels), TSH blood test ( since it can cause
hypothyroidism), and Calcium levels (since it may cause
hyperparathyroidism).
Drug interactions
• Drugs which can increase lithium levels like; NSAIDs (e.g. ibuprofen),
and blood pressure medications like ACE inhibitors, and diuretics should
not be used together with lithium medication.
• Also dehydration may cause increase in lithium dosage.
ANTIPSYCHOTICS
FIRST GENERATION (TYPICAL) ANTIPSYCHOTICS

• Also known as DRAs dopamine receptors antagonists
• The work by inhibiting dopaminergic neurotransmission.
• They effective in treating psychotic symptoms of acute mania.
• Since antimanic agents have a slower onset of action than antipsychotic in managing
acute symptoms it is standard practice to combine antipsychotic with another
antimanic such as lamotrigine.
• Example of first generation antipsychotic used in managing acute mania is haloperidol.
SECOND GENERATION (ATYPICAL)
ANTIPSYCHOTICS
• Also known as serotonin – dopamine antagonists (SDAs)

• They act by blocking both dopamine and serotonin receptors.
• They are also effective in the treatment of acute mania.
• They may be used in treatment as monotherapy or adjunctive therapy with
other antimanic.
• Example of drugs used include olanzapine and risperidone.
ELECTROCONVULSIVE THERAPY
• This procedure is done under general anesthesia in which a small electric

current is passed through to the brain, purposefully to trigger brief seizures.
• It causes changes in the brain that can quickly reverse symptoms of certain
mental health condition.
• As pharmacological agents are the first line treatment for major psychiatric
disorder, ECT is used when the patient has resistance to pharmacological
agents.
• It is used in major depressive disorders, manic episodes and schizophrenia.
Cont.……
• The relative rapidity of ECT response indicates its usefulness for patients
whose manic behavior has produced dangerous levels of exhaustion.
Non pharmacological mood stabilization
1. Exercise
2. Sleep-work cycle stabilization
3. Substance abstinence
4. Specific psychological interventions like; psychoeducation, family focused
therapy, cognitive behavioral therapy and interpersonal-social rhythm
therapy.
5. Non specific psychosocial intervention like; activities scheduling, sleep
hygiene, problem solving, social skills training and compliance strategies.
References
• Clinical pharmacology in psychiatry, L. F Gram, L.P Balant 7th edition.
• Basic notes in psychophamacology by Michael I Levi 5th edition
• History psychopharmacology by P. Lopez volume 2
• A manual clinical psychopharmacology Alan F. Schatzberg. M.D Eighth
edition
• Kaplan & Saddock 11th edition

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MOOD STABILIZERS

• Before starting medication, perform pregnancy test, Complete blood count

• Thiazides diuretics and ACE inhibitors reduce the renal clearances of

• Perform pregnancy test before start of dosage.

FIRST GENERATION (TYPICAL) ANTIPSYCHOTICS

• Also known as serotonin – dopamine antagonists (SDAs)

• This procedure is done under general anesthesia in which a small electric

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