by Dr. Manura Nanayakkara

Created on: September 22, 2010   Last Updated: April 28, 2011

Bipolar affective disorder is a common and serious mental illness. This disease is characterized by profound episodes of depression alternating with episodes of mania. It is also referred to as “creative madness” by some.

But most of the patients can lead a normal life by taking regular dose of mood stabilizer drugs. There are several types of mood stabilizers.

Lithium carbonate

Lithium is a drug with very simple structure, in fact in ionized form it is an atom. But it has one of the most complex mechanisms of actions. In addition, Lithium is considered the gold standard in treating and preventing mood disorders. 

Uses

Doctors prescribe lithium to treat and to prevent recurrence of the disorder. In addition, patients need to take this drug for at least two weeks to see an effect. It is usually started in a small dose. Then the doctor gradually increases it, until satisfactory mood stabilization is achieved. While increasing the dose, blood lithium levels are monitored to make sure patient does not get lithium toxicity. Once the mood is stabilized, patient is asked to continue the same dose to prevent the disease. In addition, patients need to check their blood lithium levels at least yearly. They also should know the side effects and toxic effects so they can identify early lithium toxicity and take medical treatment.

Side effects

Increased urine output, increased thirst, weight gain, drowsiness, fine tremors, nausea, vomiting, hair loss, acne and edema are the commonest side effects. Patients need not to worry too much about side effects. If side effects are troublesome then consulting the doctor without stopping the medication is advisable.

Toxic effects

Marked tremor, loss of appetite, severe nausea/vomiting/diarrhea and lethargy are early signs of lithium toxicity. If these features are present, then the patient must stop taking lithium and go to a hospital immediately.  

Sodium valproate

This is a commonly used anti-epileptic medication with clinically significant mood stabilization features. It is usually given along with other mood stabilizers. This medication is more effective in rapid cycling bipolar disorder (more than four depression or manic episodes in a year).  

Side effects

Anorexia, nausea, vomiting, gastritis and diarrhea are the commonest side effects. In addition, mild tremors, sedation, transient hair loss and weight gain can occur.

Carbamazepine

This drug is also a common anti-epileptic medication with mood stabilization features.  It can be given alone or with other mood stabilizers.

Side effects

Dizziness, drowsiness, headache, confusion and agitation are commonest side effects. This drug can cause electrolyte imbalance in elderly patients. Some patients may develop mild erythematous rash.

Sources

Oxford handbook of Clinical Psychiatry

British National Formulary

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