Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine >Key Medications

&Interventions in Psychiatry
Laura A. Huppert, Timothy G. Dyster, (Lead Contributing Editor)+
TABLE 13.5Mood Stabilizing Medications

Drug: Generic (Trade Name) Mechanism of action Use Side Effects

Stimulates the NMDA receptor, increasing
lithium glutamate availability in the postsynaptic neuron.
Renally cleared.
•Movement/tremor
•Nephrogenic DI (check Cr)
•HypOthyroidism (check TSH)
•Pregnancy (♥Ebstein’s anomaly of tricuspid
Bipolar disorder
leaflets)
•Toxic in deliberate overdose
Lithium blood levels: Safe level is 0.6–1.2 mEq/L
•Side effects by level of lithium elevation:
Acute: 1–1.5 mEq/L; Chronic 0.6–1.2 mEq/L
•- 1.5–2.5 mEq/L: Tremor, nausea. Tx: IV fluids.
•- 2.5–3.5 mEq/L: Renal failure. Tx: Dialysis.
•- 3.5+ mEq/L: Coma, cardiac collapse, death.
Tx: Dialysis.

•Sedation, nausea, diarrhea, weight gain, hair

Precise mechanism of action unclear – may
valproate (Depakote)
affect GABA levels and/or block Na+ channels
Bipolar disorder – Acute mania (Load 20 loss
mg/kg/d) or for chronic bipolar disorder if lithium •Hepatic toxicity (check LFTs); pancreatitis
contraindicated •Pregnancy: Neural tube defects
•Non-toxic in deliberate overdose

•Agranulocytosis, aplastic anemia

carbamazepine Blocks Na+ channel Bipolar disorder, trigeminal neuralgia •Liver injury (check LFTs)
•Teratogenic

•Steven Johnson syndrome (rare, although drug

lamotrigine (Lamictal) Blocks Na+ channel Bipolar disorder
rash is relatively common)

Date of download: 12/29/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.