Andrade: Mood Stabilizers

Question 1

Classes of mood stabilizers (3)

Answer 1

• Lithium
• Anticonvulsants
• Atypical Antipsychotics

Question 2

Anticonvulsants: (3)

Answer 2

• Valproic Acid (Divalproex is sodium salt of valproate)
• Carbamazepine
• Lamotrigine

Question 3

Atypical Antipsychotics: (5)

Answer 3

• Quetiapine
• Olanzapine
• Risperidone
• Aripiprazole
• Ziprasidone

.

Question 4

Possible MOAs:

Inhibition of Phosphatidylinositol Signaling:

Answer 4

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

Question 5

Possible MOAs:

Inhibition of Glycogen Synthase Kinase 3 Signaling:

Answer 5

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

Question 6

Lithium

Use:

Answer 6

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

Question 7

Lithium

Safety:
Absorption:
Elimination:

Answer 7

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

Question 8

Lithium

Side Effects (At Therapeutic Doses): (7)

Answer 8

• N/V/D
• Daytime drowsiness
• Polyuria
• Polydipsia
• Weight gain
• Fine tremor
• Acne

Question 9

Lithium

Toxicity: (5)

Answer 9

Toxicity: treatment for intoxication is SUPPORTIVE (no antidote)

• N/V/D
• Mental confusion
• Tremor and ataxia
• Convulsions
• Coma

Question 10

Lithium

Therapeutic index

Answer 10

Lithium has a low therapeutic index needing periodic monitoring of serum concentration

Question 11

Anticonvulsants

Efficacy:

Answer 11

Efficacy: in comparison to Li

Question 12

Valproate/Carbamazepine:

Answer 12

NOT approved for maintenance treatment

NOT protective against suicide

Use during pregnancy discouraged (Li a better choice)

Question 13

Lamotrigine:

Answer 13

Lamotrigine: only approved for maintenance treatment

Question 14

Other Anticonvulsants

Topiramate and Gabapentin:

Answer 14

Topiramate and Gabapentin: often mentioned in textbooks but have not been proven effective for the treatment of mania in well controlled clinical trials

Question 15

Atypical Antipsychotics MOA

Answer 15

Block DA-receptors

Question 16

Atypical Antipsychotics

Use:

Answer 16

Use: effective for managing both acute manic episodes (along with Li) AND perhaps maintenance, but SEs limit use

Question 17

Treatment of Bipolar Depression
Do you add an antidepressant?
What is sufficient?

Answer 17

NO: adding an antidepressant to the mood stabilizer showed no difference from placebo

Therefore, treating with a mood stabilizer alone is sufficient

Question 18

Panic Disorder

SSRIs: (4)

Answer 18

o Fluoxetine
o Sertraline
o Paroxetine
o Fluvoxamine

.

Question 19

Panic Disorder

SNRIs:

Answer 19

Venlafaxine

Question 20

Panic Disorder

TCAs/MAOIs:

Answer 20

TCAs/MAOIs: second choice

Question 21

Panic Disorder

Benzodiazepines:

Answer 21

Benzodiazepines: provide rapid relief (but not for long-term management)

Question 22

OCD

Basics:

Answer 22

Basics: disorder with high cormobidity of anxiety and mood disorders, as well as impulse control and substance use disorders

Question 23

OCD

Chlorimimpramine:

Answer 23

Chlorimimpramine: slightly superior to SSRIs

Question 24

OCD

SSRIs: (4)

Answer 24

• Fluoxetine
• Sertraline
• Paroxetine
• Fluvoxamine

.

Question 25

OCD

SNRIs:

Answer 25

Venlafaxine

Question 26

OCD

MAOIs:
NE uptake inhibitors:

Answer 26

MAOIs

Note: NE uptake inhibitors are NOT effective in the treatment of OCD