Treatment of Psychological Disorders
Mohamed Ahmed Abd El-Hay in Understanding Psychology for Medicine and Nursing, 2019
Mood stabilizers are those drugs that are effective in the treatment and prophylaxis of mania and bipolar depression. The most commonly used mood stabilizers include lithium, valproate, carbamazepine, and lamotrigine. Recently, several atypical antipsychotics, such as olanzapine, quetiapine, and aripiprazole have been added to the list of drugs used in maintenance treatment of bipolar disorder.
Life Care Planning for Depressive Disorders, Obsessive-Compulsive Disorder, and Schizophrenia
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
Valproate, an anticonvulsant, is another agent commonly used in the treatment of bipolar disorder. Valproate has demonstrated efficacy in the treatment of acute mania and some evidence of effectiveness in acute bipolar depression and maintenance (APA, 2002). Common side effects of valproate include sedation, gastrointestinal distress, tremors, increased appetite, and weight gain. There may be life-threatening adverse reactions, but such events are rare. Dosing is established through blood serum monitoring. Toxicity and overdose are not common with routine dosing. It is recommended that liver function and hematologic measures be assessed on a regular basis (APA, 2002). Other commonly prescribed mood stabilizers include carbamazepine and lamotrigine.
Special Issues in Patients with Comorbid Psychiatric and Chemical Dependency Disorders
John Brick in Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
The mood stabilizers are used to control mood swings such as those found in bipolar disorder. They are also used to reduce violent outbursts and other behaviors that accompany impulse dyscontrol conditions. The gold standard among the mood stabilizers is lithium. However, it has a very narrow therapeutic window and lithium toxicity can occur if blood levels are not monitored. Lithium is elementally close to sodium and when sodium is decreased in the body, lithium is retained—often leading to toxicity. Loss of sodium occurs whenever there is excessive vomiting, diarrhea, sweating, or decreased fluid intake. We often see these symptoms as part of the acute withdrawal syndrome in chemically dependent persons. Thus, use of lithium in this population may not be a first-line medication. The next group of medications used as mood stabilizers are the anticonvulsants. The older drugs also have a narrow therapeutic window and blood levels must be monitored for toxicity. Examples include carbamazepine (Tegretol) and divalproex (Depakote).
Antidepressant-Induced Mania with Concomitant Mood Stabilizer in Patients with Comorbid Substance Abuse and Bipolar Disorder
Published in Journal of Addictive Diseases, 2009
Daniel Lieberman, George Kolodner, Suena Massey, Kenneth Williams
ABSTRACT Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.
Alopecia and Mood Stabilizer Therapy
Published in Annals of Clinical Psychiatry, 1996
Parish A. McKinney, Ryan D. Finkenbine, C. Lindsay DeVane
Alopecia is a common side effect in patients managed on the mood stabilizers lithium, valproate, and carbamazepine. Clinicians may be reluctant to discontinue medications in patients suffering from hair loss if the mood stabilizer is otherwise efficacious. Therefore it is important to be familiar with the epidemiology, diagnosis, and management of alopecia. A single representative case is provided to illustrate briefly the common presentation of a patient with mood stabilizer-induced alopecia. A literature search was conducted to provide the basis for discussion of diagnosis, the association of mood stabilizers with alopecia, and some management options of this side effect. The diagnosis of alopecia requires an understanding of normal hair growth and is best made following a careful history, an examination, and the maintenance of a high level of suspicion. Alopecia occurs in about 10% of persons managed on lithium, up to 12% of persons on valproate, and less than 6% of individuals on carbamazepine. Management of alopecia includes reassurance, hair care techniques, trace mineral supplementation, treatment with minoxidil, and hair replacement pieces. Alopecia due to mood stabilizer drugs can be potentially identified and managed without medication discontinuation.
Adjunctive lithium and anticonvulsants for the treatment of schizophrenia: what is the evidence?
Published in Expert Review of Neurotherapeutics, 2009
Lithium and anticonvulsants are used as adjunctive agents to antipsychotic medications for the treatment of schizophrenia. However, the evidence supporting this ‘off-label’ use is relatively shallow and inconsistent. Early reports of the usefulness of lithium as an adjunctive agent have been negated by later studies. Similarly, large trials of adjunctive valproate and adjunctive lamotrigine completed in the wake of early and promising efficacy signals from smaller studies have failed to replicate the initial findings. Also problematic is the dearth of large trials of adjunctive mood stabilizers in treatment-refractory schizophrenia or persistent aggressive behavior in schizophrenia, two populations for which there remains a pressing therapeutic need for effective medication regimens. Nevertheless, on an individual patient basis there may be some benefits to be gained by adding a mood stabilizer to a medication regimen, but these must be weighed against potential adverse effects, and outcomes closely monitored so that discontinuation of the mood stabilizer is prompt should benefits not accrue.
Related Knowledge Centers
- Bipolar Disorder
- Depression
- Mood Disorder
- Mania
- Lithium
- Therapeutic Drug Monitoring
- Schizoaffective Disorder