Benefits of mood stabilizers
To treat mania:
To treat acute depression
Very very effective, but dangerous.
Begin at 300 mg, assess levels, and then move it up after 5 days.
Dosing is 600-1800 mg/day; aim for serum levels of 0.8-1.1 mmol/L for adults and 0.4-0.6 mmol/L
baseline labs: renal functioning, TSH
obtain serum levels 5 days after the most recent dose titration, 12 h after the dose. Once at a effective dose, follow bloodwork for a few weeks, then move to testing every 3 months or so.
Lithium toxicity is bad news: follow lithium blood levels and drink lots of water.
CNS: fatigue, dysphoria, fine tremor
GI: nausea, vomiting, diarrhea, weight gain
CVS: benign T wave changes, sinus
can damage kidneys (1:500-1:1000)
Lithium collects in the collecting tubules, where it can lead to ADH resistance. This should be avoided in combination with other drugs causing volume depletion or which prevent the kidneys from compensating.
Chronic interstitial nephritis can occur in 15-20% of long term users of lithium.
Nephrotic syndrome (minimal change disease or focal segmental glomerulosclerosis can occur.
Renal tubular acidosis can follow reduced activity of H+ ATPase in collecting tubule.
endocrine: hypothyroidism, hypoparathyroidism
Other symptoms include cognitive impairment, tremor, acne, psoriasis, polydypsia, polyuria, edema, nausea and vomiting.
4-12% rate of congenital malformations: Epbstein anomaly, polyhydramnios, preterm delivery
Toxicity is usually chronic, though acute overdose is always possible. Precipitants include renal failure or dehydration.
Treatment includes supportive measures, hypotonic IV, and hemodialysis if levels are over 4 or with significant symptoms
Concequences of stopping medication