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11 Cards in this Set
- Front
- Back
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Mood stabilisers
When would you use a mood stabiliser? |
BPAD for Tx and proph of mania, and Tx of depression (lesser effect)
Augmentation of antideps in Tx-res unipolar depression |
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Li
Pharmacokinetic principles of lithium How often should you check blood levels? |
Uses Na-transport - thus Na balance may alter Li
Blood test 12hrs after last dose, want a maintenance level betw 0.4 - 1 mmol/L. Initial tests wkly then eventually 3-monthly once stabilised |
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Indications
How good is lithium as an antidepressant augment? |
Main ind: "best" Tx / proph of mania
In Tx-res dep, adding Li can be as effective as ECT! |
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Be careful about giving Li to:
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Anyone with cardiac / renal problems
Pregnancy / BF |
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What does lithium interact with?
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Things that mess with Li renal excr: diuretics, NSAIDs, ACEIs
Neurotoxicity: MAOIs, SSRIs, carbamazepine, high-dose antipsychotics |
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What are key adverse effects of lithium?
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Polyuria and polydipsia
Fine tremor GI upset Oedema, wt gain Hypothyroidism, goitre ECG changes Advise that these will generally get better with time. |
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Lithium intoxication
When might this occur? What will you see clinically? |
Rare below 1.5 mmol/L, BUT can occur within the therapeutic range.
"Quite obvious" when you see it - ++ unwell pt with anorexia, vomiting, diarrhoea, weakness, ataxia, drowsiness, confusion, coma, progression to renal and circ failure, convulsions, death |
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Before starting Li, what should you check and why?
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U & Es (check baseline renal function; Li is an electrolyte!!) TFTs (Li can mess w thyroid fn)
ECG |
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Name some non-lithium mood stabilisers
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Sodium valproate
Lamotrigine Carbamazepine |
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On carbamezapine:
What is this? How effective is it? What are its adverse effects? Does it have any significant interactions? |
Carbamazepine - antiepileptic, but also mood stabiliser
Efficacy - unclear, but 'less toxic' than Li. SEs - drowsiness, neutropenia. Interacts with Li and MAOIs to produce neurotoxicity |
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How do these agents compare for antidepressant augmentation in unipolar depression?
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Not as good as Li
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