Mood Stabilizers

Question 1

What are mood stabilizers?

Answer 1

Medications that are used to primarily treat bipolar disorder. Mood stabilizers work by decreasing abnormal activity in the brain and can also treat depression (usually with an anti-depressant), schizoaffective disorder, disorders of impulse control, and certain mental illnesses in children.

Question 2

What drugs are used as mood stabilizers?

Answer 2

Lithium is one of the most common and first line medications used in bipolar disorder as well as other mood disorders.

Anticonvulsant medications are also used even though they’re used to treat epilepsy traditionally. Valproic acid is the most effective mood stabilizing anticonvulsant therapy (carbamazepine, lamotrigine, and oxcarbazepine can also be used).

Second generation antipsychotics are also used, which include olanzepine, quetiapine, and risperidone. These are generally used in the manic episodes of BPD.

Question 3

Valproic acid

Answer 3

Divalproex, AED

Used in BPD type 1, seizure disorders, and migraine prevention. Used in children for seizure therapy only.

May also be used adjunctively in treating schizophrenia and behaviour related problems in patients with dementia/Alzheimer’s.

Loading dose 20mg/kg/day, twice per day dosing. Serum levels should be 350-700mmol/L.

Question 4

Lithium

Answer 4

An element/alkali metal that is given as a salt (lithium carbonate).

Used in BPD and adults and children >12. It is an excellent drug for both acute episodes (mania usually) and disease maintenance.

300-1200mg daily dosing.
Levels:
0.8-1.2 in adults
0.5-0.7 in elderly adults

Question 5

Olanzepine

Answer 5

Zyprexa, 2nd generation antipsychotic

Used in acute mixed or manic episodes in adults with BPD type 1, maintenance for BPD type 1, and schizophrenia.

2.5-20mg dosing.

Question 6

Quetiapine

Answer 6

Seroquel, 2nd generation antipsychotic

Used in BPD depressed or manic phase, maintenance in BPD, and schizophrenia.

25-400mg dosing.

Question 7

Risperidone

Answer 7

Risperdal, 2nd generation antipsychotic

Used in BPD type 1 (manic or mixed), schizophrenia, and autistic disorder (children aged 5-16). Also may be used for aggression, false perception, Tourette’s syndrome, and behavioural problems in mentally delayed patients.

0.25-4mg dosing.

Risperdal Consta is an extended release that can be 12.5-50mg dosing.