Drugs Used to Stabilise Moods
Introduction
Mood stabilisers are used primarily to reduce the severity of mood swings in bipolar disorders, depression and other mood disorders. Besides Lithium, the other mood stabilisers can be used to control some types of seizures (fits) in the treatment of epilepsy. Sodium Valproate can also be used to prevent migraine headaches, while Carbamazepine is used to relieve symptoms of facial nerve pain.
How to Use These Medicines
Mood stabilisers come in forms such as tablets (ordinary, enteric-coated, controlled-release or extended-release) and liquids. Liquids can be mixed in drinking water, fruit juice or low-fat milk. They cannot be mixed into any carbonated drink. Extended-release, enteric-coated or controlled-released tablets need to be swallowed whole with water or other liquids and should not be split, crushed or chewed. You are advised to avoid grapefruit juice while on Sodium Valproate, Lamotrigine and Carbamazepine.
Take the medicine as prescribed by the doctor. Do not take more or less of it. Continue to take this medicine regularly even if you feel well. Some other medicines may affect how they work. Tell your doctors, pharmacists, dentists and other health care providers who treat you about all medicines and natural remedies that you are taking.
Side Effects
Common
The following side effects may lessen or go away with time.
Let your doctor know if any of these persists or affects you significantly.
| Carbamazapine | Lamotrigine | Lithium | Sodium valproate |
| Dizziness | Dizziness | ||
| Drowsiness | Drowsiness | ||
| Headach | Headach | Headach | |
| Nausea or vomiting | Nausea or vomiting | Nausea or vomiting | Nausea or vomiting |
| Stomach discomfort | Stomach discomfort | Stomach discomfort | Stomach discomfort |
| Diarrhoea or constipation | Diarrhoea or constipation | Diarrhoea or constipation | Diarrhoea |
| Dry mouth | Dry mouth | ||
| Clumsiness or unsteadiness | |||
| Fine tremor | |||
| Trembling of hands and arms | |||
| Increase in appetite or weight gain | |||
| Slight initial and temporary hair loss |
Rare but Serious Side Effects
These are some rare but serious side effects of mood stabiliser medicines. If you experience any of these adverse effects, stop the medication immediately and see your doctor as soon as possible. These include:
- Allergic reaction: skin rash or itch, difficulty breathing, swelling in the face, lips or other parts of the body
- Confusion, clumsiness and unsteadiness, severe weakness
- Seizures (fits)
- Blurred or double vision
- Unusual bruising or bleeding
Other Significant Side Effects Specific to Individual Drugs
| Carbamazepine | Lamotrigine | Sodium valproate | Lithium |
| Fever, chills, sore throat, mouth ulcers or sores | Fever, chills, sore throat, mouth ulcers or sores | ||
| Yellowing of eyes or skin | Yellowing of eyes or skin | ||
| Thoughts about harming or killing yourself | Thoughts about harming or killing yourself | ||
| Chest pain, fast, pounding or irregular heartbeat | Irregular heart beat | ||
| Blistering, peeling, red skin rash | |||
| Change in how much or how often you urinate | |||
| Dark coloured urine or pale stools | |||
| Severe loss of appetite, stomach pain and vomiting that does not go away | Severe loss of appetite, stomach pain and vomiting that does not go away | ||
| Severe shaking / tremor |
Lamotrigine
Check with your doctor immediately if you develop a skin rash.
Lithium
Its effectiveness is affected by its concentration in your blood. Therefore, it is important to comply with all appointments with your doctor. Your doctor may order blood tests to monitor your response to lithium. The amount of salt in the diet can also affect the level of lithium in the blood. Do not change your diet from a high to low salt diet or vice versa. Drink plenty of fluids (at least 8 – 12 glasses of water or other beverage per day) when you exercise or during hot weather as you may lose large amounts of water and salt from your body under such conditions. Excessive loss of water can cause serious side effects. Avoid drinking too much caffeinated beverages, such as tea, coffee, cola or chocolate milk. If you have an infection or illness that causes heavy sweating, vomiting or diarrhoea, consult the doctor immediately.
Pregnancy and Breastfeeding
Some mood stabilisers (Carbamazepine, Sodium Valproate and Lamotrigine) may decrease the efficacy of hormonal contraceptives (e.g. birth control pills, patches, rings, injections, implants or intrauterine devices). Therefore, it is advisable to use other forms of birth control (such as condoms, diaphragms or coils) while on medication.
Mood stabilisers should be used in pregnancy only when the benefits outweigh the risks. As such, discuss with your doctor prior to starting treatment if you plan to get pregnant. Drugs such as Carbamazepine and Sodium Valproate may appear in breast milk in low amounts.
The use of Lithium during breastfeeding is not recommended because its amount in breast milk is significant enough to increase the risk of toxicity in infants. Lamotrigine may appear in breast milk but there is limited data to suggest that the drug exerts no harmful effects in infants.
Stopping Medication
Do not stop taking your medicines suddenly without talking to your doctor, especially if you have been taking them in high doses and/or for a long period of time. Otherwise, your condition may worsen.
Source: ABCs of Psychiatric Medication (EDITOR Dr Rathi Mahendran) INSTITUTE OF MENTAL HEALTH Oct 2011
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