Mood Stabilisers

These drugs are mainly used for people with mood disorders including Bipolar affective disorder (also known as Manic Depression), mania or hypomania and depression. They include Lithium Carbonate, Carbamazepine and Sodium Valproate.

Lithium

Lithium is used to treat manic and hypomanic episodes. It is also effective in reducing the number and severity of relapses, although is more effective in treating manic than depressive episodes. Long term treatment with lithium has been shown to reduce the risk of suicide in people with Bipolar Affective Disorder. Clinical improvements can be noticed after a week of treatment, whereas side-effects are evident from the beginning of treatment. These can include nausea, loose bowels, urinary frequency, tiredness, hand tremor and thirst. Abrupt cessation of lithium is associated with increased risk of relapse and should be avoided. In the longer term Lithium can lead to an underactive thyroid gland (hypothyroidism, usually managed with thyroxine replacement) and kidney damage. For this reason routine monitoring of blood lithium levels, thyroid and kidney function is required. Lithium levels are generally checked every three months once the levels are stable, with thyroid and kidney function checked 6 or 12 monthly. Lithium Toxicity can occur when blood lithium levels are too high. This can occur when a patient is dehydrated which can occur with a fever, or not drinking enough on hot days. Lithium toxicity causes loss of appetite, nausea, diarrhoea, muscle weakness, coarse tremor, drowsiness and difficulty walking. If levels continue to increase confusion, loss of consciousness, seizures and coma followed by death can occur. Medical investigation and treatment is required in a patient taking Lithium who experiences any of these symptoms.

Sodium Valproate

Sodium Valproate is used in the treatment of epilepsy, acute mania and bipolar affective disorder and in patients who also have depressive symptoms Sodium Valproate is particularly effective. Side effects include gastric irritation, nausea, lethargy, confusion, weight gain, hair loss and leg swelling. Serious liver disease and blood changes can occur and blood counts should be checked if there are any symptoms. Monitoring of blood levels, for compliance and therapeutic levels can be helpful. Sodium Valproate is known to cause foetal malformations and polycystic ovarian disease; special care is required when prescribing for women of child bearing age.  

Carbamazepine

Carbamazepine is another anticonvulsant medication which can be used in mania and bipolar affective disorder, but is not generally used when Lithium and Sodium Valproate have been ineffective. Side effects include nausea, difficulties walking (ataxia), sedation and dizziness. Rash is a common side effect and in a small number severe skin reactions can occur. Regular monitoring of full blood count and liver function is required as rare but serious blood and liver disease can develop. Carbamazepine can also interact with other medications and dose adjustments may be required.