13.3 Mood Stabilizers
3 min read•june 18, 2024
are crucial in managing , with as the gold standard. These medications work by modulating neurotransmitters, offering neuroprotection, and regulating mood. They prevent manic and depressive episodes, reducing the frequency and severity of mood swings.
Lithium and like , , and are the main mood stabilizers. Each has unique effects and side effects, requiring careful monitoring and patient education. Nurses play a vital role in assessing, monitoring, and educating patients on these medications.
Mood Stabilizers
Key features of mood stabilizers
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- Lithium serves as the gold standard treatment for bipolar disorder by reducing frequency and severity of manic and depressive episodes through modulation of (, , and ), neuroprotective effects via increased (), and inhibition of () which regulates mood and
- Anticonvulsants (, , lamotrigine) are used as alternatives or adjuncts to lithium
- Valproic acid and carbamazepine enhance neurotransmission leading to mood stabilization and reduce neuronal excitability while modulating dopamine and serotonin systems
- Lamotrigine blocks stabilizing neuronal membranes and reduces glutamate release contributing to mood stabilization
Effects of lithium and anticonvulsants
- Lithium prevents manic and depressive episodes, reduces suicide risk, but has side effects including , , , weight gain, , , and a narrow requiring regular
- Drug interactions with , , and can increase lithium levels
- Valproic acid reduces manic episodes and but may cause nausea, vomiting, weight gain, , , , and interacts with aspirin, warfarin, and other anticonvulsants
- Carbamazepine reduces manic episodes and rapid cycling with side effects of dizziness, drowsiness, nausea, liver enzyme induction, , and interactions with oral contraceptives, warfarin, and other anticonvulsants
- Lamotrigine prevents depressive episodes and rapid cycling but may lead to dizziness, drowsiness, headache, rash (including rare but serious ), and interacts with valproic acid, carbamazepine, and oral contraceptives
Pharmacokinetics and Safety Considerations
- is crucial for mood stabilizers, especially lithium, as the difference between therapeutic and toxic doses is narrow
- of mood stabilizers influence dosing schedules and potential for
- can affect medication adherence and alter drug metabolism
- Long-term use of some mood stabilizers may lead to , requiring careful monitoring
- Drug-drug interactions can significantly impact mood stabilizer efficacy and safety
Nursing care for mood stabilizer patients
- Assessment involves evaluating mental status, mood, behavior, medication adherence, side effects, (lithium, valproic acid), renal and (lithium), (valproic acid, carbamazepine), and (carbamazepine, lamotrigine)
- Monitoring includes regular serum drug level measurements (lithium, valproic acid), periodic renal, thyroid, liver, and hematologic function tests, mood, behavior, treatment response, and emergence of side effects or adverse reactions
- Interventions involve administering medications as prescribed, educating patients and families about medication use, side effects, and importance of adherence, encouraging healthy lifestyle habits (regular sleep, exercise, stress management), collaborating with mental health professionals for comprehensive care, and adjusting medication dosages or switching medications as needed based on clinical response and side effects
Patient education for mood stabilizers
- Emphasize the importance of medication adherence for preventing relapses and maintaining stability
- Inform patients about common side effects and encourage reporting of severe or persistent side effects to healthcare providers
- Stress the significance of regular blood tests and monitoring for safety and dose adjustments
- Advise patients to avoid abrupt discontinuation of mood stabilizers as this can lead to relapse or withdrawal symptoms
- Educate about potential drug interactions and the need to inform all healthcare providers about mood stabilizer use
- Highlight the importance of a healthy lifestyle including regular sleep, exercise, and stress reduction techniques
- Encourage open communication with healthcare providers and support systems about mood changes and treatment concerns
- Provide resources for additional support such as therapy, support groups, and crisis hotlines
Key Terms to Review (62)
ACE Inhibitors: ACE (Angiotensin-Converting Enzyme) inhibitors are a class of medications that work by blocking the action of the angiotensin-converting enzyme, which is responsible for converting angiotensin I into angiotensin II, a potent vasoconstrictor. By inhibiting this enzyme, ACE inhibitors help lower blood pressure and reduce the workload on the heart.
Agranulocytosis: Agranulocytosis is a severe and potentially life-threatening condition characterized by a significant reduction in the number of granulocytes, a type of white blood cell that plays a crucial role in the body's immune response. This term is particularly relevant in the context of mood stabilizers and thyroid/antithyroid drugs, as these medications can potentially induce this adverse effect.
Anticonvulsants: Anticonvulsants are a class of medications primarily used to prevent and control seizures associated with epilepsy. They work by stabilizing the electrical activity in the brain, reducing the likelihood of abnormal neuronal firing that can lead to seizures. These drugs have applications beyond just epilepsy, as they are also used to treat other neurological and psychiatric conditions.
Antidiarrheal: Antidiarrheals are medications used to alleviate or stop diarrhea by slowing down gut movement or absorbing excess fluid in the intestines. These drugs help restore normal bowel function and prevent dehydration.
Antiseizure medications: Antiseizure medications, also known as antiepileptic drugs (AEDs), are used to control seizures in individuals with epilepsy and other seizure disorders. They work by stabilizing electrical activity in the brain.
BDNF: BDNF, or Brain-Derived Neurotrophic Factor, is a protein that plays a crucial role in the growth, development, and maintenance of neurons in the brain. It is a member of the neurotrophin family of growth factors and is essential for the survival and function of neurons, particularly in the context of mood stabilizers.
Bipolar Disorder: Bipolar disorder is a mental health condition characterized by extreme mood swings between manic episodes of elevated energy, mood, and activity, and depressive episodes of low mood, energy, and motivation. This condition is closely linked to the use of antipsychotics and mood stabilizers in clinical practice.
Brain-Derived Neurotrophic Factor: Brain-Derived Neurotrophic Factor (BDNF) is a protein that plays a crucial role in the growth, development, and survival of neurons in the brain. It is a member of the neurotrophin family of growth factors, which are essential for the proper functioning and maintenance of the nervous system.
Caplyta: Caplyta (lumateperone) is an atypical antipsychotic medication used primarily for the treatment of schizophrenia and bipolar depression. It works by modulating dopamine, serotonin, and glutamate receptors in the brain.
Carbamazepine: Carbamazepine is an anticonvulsant medication used primarily to manage epilepsy and bipolar disorder. It stabilizes hyperactive nerve membranes and reduces synaptic transmission.
Carbamazepine: Carbamazepine is an anticonvulsant and mood stabilizing medication primarily used in the treatment of epilepsy and bipolar disorder. It works by modulating the activity of sodium channels in the brain, which helps to prevent the abnormal electrical activity that leads to seizures and mood episodes.
Depakote: Depakote (divalproex sodium) is a medication used primarily to treat seizure disorders, bipolar disorder, and to prevent migraine headaches. It functions by increasing the amount of certain neurotransmitters in the brain.
Depakote ER: Depakote ER is an extended-release formulation of divalproex sodium, used primarily for managing bipolar disorder, epilepsy, and migraine prophylaxis. It helps stabilize mood by affecting neurotransmitter levels in the brain.
Diarrhea: Diarrhea is the condition characterized by frequent, loose, and watery bowel movements. It is a common gastrointestinal symptom that can be caused by a variety of factors and can have implications across different medical disciplines, including Alzheimer's drugs, mood stabilizers, expectorants, laxatives, histamine blockers, and prostaglandin analogues.
Dopamine: Dopamine is a neurotransmitter that plays a crucial role in the brain's reward and pleasure centers, as well as in the regulation of various physiological processes. It is involved in a wide range of functions, from motor control and cognition to emotional and behavioral responses, making it a key player in understanding and treating numerous nervous system disorders.
Drug-Drug Interactions: Drug-drug interactions occur when the effects of one drug are altered by the presence of another drug, leading to changes in the intended therapeutic outcome. These interactions can enhance or diminish the effectiveness of the drugs involved, and they are an important consideration in pharmacology, interdisciplinary teams, and nursing practice.
GABA: GABA (Gamma-Aminobutyric Acid) is the primary inhibitory neurotransmitter in the central nervous system. It plays a crucial role in regulating neuronal excitability and has been associated with various neurological and psychiatric disorders, including Parkinson's disease, epilepsy, mood disorders, and alcohol use disorder.
GABA structural analogs: GABA structural analogs are compounds that mimic the structure of gamma-aminobutyric acid (GABA), a neurotransmitter. These analogs are used to modulate neural activity and are often employed in the treatment of neurological conditions such as multiple sclerosis.
Glutamate: Glutamate is the principal excitatory neurotransmitter in the mammalian central nervous system, playing a crucial role in various neurological processes and disorders affecting the brain and nervous system.
Glycogen Synthase Kinase-3: Glycogen synthase kinase-3 (GSK-3) is a serine/threonine protein kinase that plays a crucial role in various cellular processes, including glucose metabolism, cell signaling, and regulation of gene expression. It is a key component in the regulation of glycogen synthesis and is closely associated with mood stabilizer mechanisms in the context of mental health disorders.
GSK-3: GSK-3, or Glycogen Synthase Kinase-3, is a serine/threonine protein kinase that plays a crucial role in various cellular processes, including mood regulation, metabolism, and neuronal function. It is a key component in the pathophysiology and treatment of mood disorders, making it an important target for mood stabilizer medications.
Hematologic Parameters: Hematologic parameters refer to the various measurements and characteristics of the blood and its cellular components, including red blood cells, white blood cells, and platelets. These parameters provide important insights into an individual's overall health and can be used to monitor and diagnose various medical conditions.
Hepatotoxicity: Hepatotoxicity is the occurrence of liver damage due to exposure to certain substances, including drugs. It can lead to serious health complications and requires careful monitoring.
Hepatotoxicity: Hepatotoxicity refers to the potential for certain drugs, chemicals, or other substances to cause liver damage or dysfunction. It is a critical consideration in the development and use of various medications and treatments.
Hypothyroidism: Hypothyroidism is a condition in which the thyroid gland produces an insufficient amount of thyroid hormones, leading to a slowing of various metabolic processes in the body. This term is relevant across multiple topics, including osmolality, vitamins and minerals, mood stabilizers, potassium channel blockers, growth hormones, thyroid and parathyroid functions, thyroid and antithyroid drugs, and weight management.
Lamictal: Lamictal, also known as lamotrigine, is an anticonvulsant and mood stabilizer used to treat epilepsy and bipolar disorder. It helps prevent seizures and stabilize mood swings by modulating neurotransmitter activity in the brain.
Lamotrigine: Lamotrigine is an anticonvulsant medication used primarily to treat epilepsy and bipolar disorder. It works by stabilizing neuronal membranes and inhibiting the release of excitatory neurotransmitters like glutamate.
Lithium: Lithium is a mood stabilizer commonly used to treat bipolar disorder. It helps to reduce the frequency and severity of manic and depressive episodes.
Liver Function: Liver function refers to the essential roles the liver plays in the body, including metabolic, digestive, and detoxification processes. As a vital organ, the liver is responsible for a wide range of critical functions that maintain overall health and homeostasis.
Lumateperone: Lumateperone is an antipsychotic medication used to treat schizophrenia and bipolar depression. It works by modulating neurotransmitter activity in the brain, including dopamine, serotonin, and glutamate systems.
Mania: Mania is a state of abnormally elevated mood, energy, and activity levels, often accompanied by racing thoughts, impulsivity, and decreased need for sleep. It is a key feature of bipolar disorder and can significantly impact an individual's ability to function in daily life.
Mood Episodes: Mood episodes refer to distinct periods of time characterized by a significant change in an individual's emotional state, which can include episodes of mania, hypomania, or depression. These mood episodes are a central feature of various mood disorders, such as bipolar disorder, and are a key consideration in the management and treatment of these conditions.
Mood Stabilizers: Mood stabilizers are a class of medications primarily used to treat bipolar disorder and other mood-related conditions. They help regulate and stabilize mood, preventing extreme highs (mania) and lows (depression) associated with these disorders.
Nausea: Nausea is an unpleasant sensation of discomfort in the upper stomach, often accompanied by an urge to vomit. It is a common symptom that can arise from various physiological and psychological factors, and it is particularly relevant in the context of the provided topics: Alzheimer's Drugs, Mood Stabilizers, Expectorants and Mucolytics, Xanthines, Leukotriene Modifiers, and Mast Cell Stabilizers, as well as Pepsin Inhibitors and Prostaglandin Analogues.
Nephrogenic Diabetes Insipidus: Nephrogenic diabetes insipidus is a condition characterized by the kidneys' inability to respond properly to the antidiuretic hormone (ADH), also known as vasopressin. This results in excessive production of dilute urine and frequent urination, leading to dehydration and electrolyte imbalances. The term 'nephrogenic' indicates that the underlying cause is related to the kidneys, as opposed to the pituitary gland, which is the case in central diabetes insipidus.
Neuroplasticity: Neuroplasticity is the brain's ability to reorganize itself by forming new neural connections throughout life. It allows neurons in the brain to compensate for injury and disease, and to adjust their activities in response to new situations or changes in their environment.
Neuroplasticity: Neuroplasticity refers to the brain's ability to adapt, change, and reorganize itself in response to new experiences, learning, and environmental demands. It is a fundamental property of the nervous system that allows the brain to modify its structure and function throughout an individual's lifetime.
Neurotoxicity: Neurotoxicity refers to the harmful or adverse effects that certain substances, chemicals, or agents can have on the structure and/or function of the nervous system, including the brain, spinal cord, and peripheral nerves. It is a critical consideration in the context of various drug classes and their potential to cause neurological complications.
Neurotransmitter Systems: Neurotransmitter systems refer to the complex networks of chemical messengers in the brain that facilitate communication between neurons. These systems play a crucial role in regulating various physiological and psychological processes, including mood, cognition, and behavior, which are particularly relevant in the context of mood stabilizers.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that reduce inflammation, pain, and fever without the use of steroids. They inhibit cyclooxygenase enzymes (COX-1 and COX-2), which are involved in the production of prostaglandins.
NSAIDs: NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs, are a class of medications that are widely used to reduce inflammation, alleviate pain, and lower fever. They work by inhibiting the production of prostaglandins, which are key mediators of the inflammatory response. NSAIDs are commonly employed in the management of various conditions, including arthritis, menstrual cramps, headaches, and post-operative pain.
Pancreatitis: Pancreatitis is a condition characterized by inflammation of the pancreas, a vital organ responsible for producing enzymes that aid in digestion and hormones that regulate blood sugar levels. This condition can have significant implications in the context of mood stabilizers and diabetes management.
Pediatric clients: Pediatric clients are children and adolescents who require medical care, including pharmacological treatments. Special considerations must be made for their unique physiological and developmental needs.
Pharmacokinetics: Pharmacokinetics is the study of how the body affects a drug, including the processes of absorption, distribution, metabolism, and elimination. It examines the movement of drugs within the body and how these processes impact the drug's concentration and duration of action.
Rapid Cycling: Rapid cycling is a pattern of mood episodes in bipolar disorder where an individual experiences four or more distinct mood episodes (manic, hypomanic, or depressive) within a 12-month period. This rapid alternation between mood states is a distinct feature of certain types of bipolar disorder and can significantly impact an individual's quality of life and functioning.
Renal Function: Renal function refers to the ability of the kidneys to filter blood, regulate fluid and electrolyte balance, and excrete waste products from the body. It is a crucial physiological process that maintains homeostasis and supports various bodily systems.
Selective serotonin receptor agonists: Selective serotonin receptor agonists are drugs that specifically target and activate serotonin receptors in the brain to alleviate migraine headaches. They primarily work by narrowing blood vessels and reducing inflammation.
Serotonin: Serotonin is a neurotransmitter that plays a crucial role in regulating various physiological and psychological processes in the body. It is involved in the functioning of the nervous system, the regulation of mood, sleep, appetite, and other important bodily functions.
Serum Drug Levels: Serum drug levels refer to the concentration of a specific drug or medication present in an individual's bloodstream. This measurement is crucial in understanding the pharmacokinetics and pharmacodynamics of a drug, particularly in the context of mood stabilizer medications used to manage conditions like bipolar disorder.
Serum drug levels provide valuable insights into how the body absorbs, distributes, metabolizes, and eliminates a particular drug, allowing healthcare providers to optimize dosing and monitor the effectiveness of the treatment.
Serum Level Monitoring: Serum level monitoring is the process of measuring the concentration of a specific drug or substance in a patient's blood serum. This is an important tool in the management of various medical conditions, particularly for drugs with a narrow therapeutic index or those that require careful dose titration to achieve the desired therapeutic effect while minimizing the risk of adverse reactions.
Stevens-Johnson Syndrome: Stevens-Johnson syndrome (SJS) is a rare, serious, and potentially life-threatening skin condition that typically begins with flu-like symptoms followed by a painful rash that spreads and blisters, eventually causing the top layer of the skin to die and shed. This condition is often triggered by certain medications and can affect the eyes, mouth, and genitals as well.
Subvenite: Subvenite is a proprietary mood stabilizer used in the treatment of bipolar disorder and other mood disorders. It helps to balance neurotransmitters in the brain, reducing the frequency and severity of mood swings.
Tegretol: Tegretol is an anticonvulsant medication used primarily to treat epilepsy and bipolar disorder. It works by reducing abnormal electrical activity in the brain.
Teratogenicity: Teratogenicity refers to the ability of a substance, such as a drug or chemical, to cause developmental abnormalities or birth defects in a developing fetus. It is a crucial consideration in the context of various medical conditions and treatments.
Therapeutic index: Therapeutic index (TI) is the ratio of the toxic dose to the therapeutic dose of a drug, indicating its safety margin. A higher TI means a greater margin between effective and toxic doses, making the drug safer.
Therapeutic Index: The therapeutic index, also known as the therapeutic ratio, is a measure of the relative safety of a drug. It is the ratio between the dose that causes a toxic effect and the dose that produces the desired therapeutic effect. A higher therapeutic index indicates a wider margin of safety for a drug, meaning it has a lower risk of causing adverse effects when used at the recommended therapeutic dose.
Thiazide Diuretics: Thiazide diuretics are a class of medications primarily used to treat hypertension, edema, and certain types of kidney stones. They work by inhibiting the reabsorption of sodium and chloride in the distal convoluted tubule of the nephron, leading to increased excretion of water, sodium, and other electrolytes. This diuretic effect helps to lower blood pressure and reduce fluid buildup in the body.
Thyroid Function: Thyroid function refers to the regulation and activity of the thyroid gland, a small, butterfly-shaped endocrine gland located in the neck. The thyroid gland produces hormones that play a crucial role in various physiological processes, including metabolism, growth, and development. Understanding thyroid function is essential in the context of mood stabilizers, as thyroid dysfunction can significantly impact an individual's mental health and response to treatment.
Tremor: A tremor is an involuntary, rhythmic shaking movement of a body part, often the hands, head, or voice. Tremors can be a symptom of various neurological and medical conditions, and they can also occur as a side effect of certain medications.
Valproic acid: Valproic acid is a medication primarily used to treat epilepsy and bipolar disorder. It also has applications in preventing migraine headaches.
Valproic Acid: Valproic acid is a medication primarily used to treat epilepsy, migraine headaches, and mood disorders. It is an anticonvulsant drug that works by stabilizing electrical activity in the brain, reducing the frequency and severity of seizures, and modulating neurotransmitter levels to alleviate symptoms associated with various neurological and psychiatric conditions.
Voltage-Gated Sodium Channels: Voltage-gated sodium channels are specialized transmembrane proteins found in the cell membranes of excitable cells, such as neurons and muscle cells. These channels are responsible for the generation and propagation of action potentials, which are the electrical signals that allow for rapid communication within the body.