Andrade: Mood Stabilizers Flashcards
(26 cards)
Classes of mood stabilizers (3)
- Lithium
- Anticonvulsants
- Atypical Antipsychotics
Anticonvulsants: (3)
- Valproic Acid (Divalproex is sodium salt of valproate)
- Carbamazepine
- Lamotrigine
Atypical Antipsychotics: (5)
- Quetiapine
- Olanzapine
- Risperidone
- Aripiprazole
- Ziprasidone
.
Possible MOAs:
Inhibition of Phosphatidylinositol Signaling:
Inhibition of Phosphatidylinositol Signaling:
o Lithium: prevents recycling of inositol phospholipids, preventing the formation of PIP2
o Valproic Acid: also inhibits an enzyme leading to the metabolism of inositol phospholipids
OVERALL POINT: these are just suggested ideas- the actual mechanism remains unclear
Possible MOAs:
Inhibition of Glycogen Synthase Kinase 3 Signaling:
Inhibition of Glycogen Synthase Kinase 3 Signaling:
o GSK-3 Function: besides being involved in the synthesis of glycogen, also a kinase that participates in the signaling of very important molecules called WNT
o Inhibition of this pathway: by BOTH lithium and valproic acid
OVERALL POINT: these are just suggested ideas- the actual mechanism remains unclear
Lithium
Use:
Effective in the treatment of mania and prevention of recurrent attacks
- Acute Mania: Li plus antipsychotic or potent benzodiazepine
- Maintenance: monotherapy is effective, but frequently combine with valproate or carbamazepine
Also protective against suicide
Lithium
Safety:
Absorption:
Elimination:
Safety: has a LOW THERAPEUTIC INDEX; therefore, periodic monitoring of serum concentration is necessary
Absorption: readily absorbed from GI tract
Elimination: by the kidney in the urine
- Changes in kidney Na clearance (ie. diuretics) affect plasma Li concentration
Lithium
Side Effects (At Therapeutic Doses): (7)
- N/V/D
- Daytime drowsiness
- Polyuria
- Polydipsia
- Weight gain
- Fine tremor
- Acne
Lithium
Toxicity: (5)
Toxicity: treatment for intoxication is SUPPORTIVE (no antidote)
- N/V/D
- Mental confusion
- Tremor and ataxia
- Convulsions
- Coma
Lithium
Therapeutic index
Lithium has a low therapeutic index needing periodic monitoring of serum concentration
Anticonvulsants
Efficacy:
Efficacy: in comparison to Li
Valproate/Carbamazepine:
NOT approved for maintenance treatment
NOT protective against suicide
Use during pregnancy discouraged (Li a better choice)
Lamotrigine:
Lamotrigine: only approved for maintenance treatment
Other Anticonvulsants
Topiramate and Gabapentin:
Topiramate and Gabapentin: often mentioned in textbooks but have not been proven effective for the treatment of mania in well controlled clinical trials
Atypical Antipsychotics MOA
Block DA-receptors
Atypical Antipsychotics
Use:
Use: effective for managing both acute manic episodes (along with Li) AND perhaps maintenance, but SEs limit use
Treatment of Bipolar Depression
Do you add an antidepressant?
What is sufficient?
NO: adding an antidepressant to the mood stabilizer showed no difference from placebo
Therefore, treating with a mood stabilizer alone is sufficient
Panic Disorder
SSRIs: (4)
o Fluoxetine
o Sertraline
o Paroxetine
o Fluvoxamine
.
Panic Disorder
SNRIs:
Venlafaxine
Panic Disorder
TCAs/MAOIs:
TCAs/MAOIs: second choice
Panic Disorder
Benzodiazepines:
Benzodiazepines: provide rapid relief (but not for long-term management)
OCD
Basics:
Basics: disorder with high cormobidity of anxiety and mood disorders, as well as impulse control and substance use disorders
OCD
Chlorimimpramine:
Chlorimimpramine: slightly superior to SSRIs
OCD
SSRIs: (4)
- Fluoxetine
- Sertraline
- Paroxetine
- Fluvoxamine
.
