Mood Stabilizers
Divya K Y
M.S.N, RN
Lecturer, community and mental health Nursing
department
Mood Stabilizer
Mood stabilizer are usually
used to treat bipolar
disorder.
Mood stabilizer balances
between both elevated
mood and depressed mood.
Mood Stabilizer
Anti manic: Lithium carbonate 1800-2400mg
Anti convulsant:
Eg: Clonazepam : 0.5-20mg
Carbamazepine : 200-1600mg
Valproic Acid : 5mg/kg-60mg/kg
Lamotragine: 100-200mg
Topiramate: 50-400mg
Calcium channel blocker:
Eg: Verapamil 80-320mg
Indication
Talkativeness
Grandiosity
Distractibility
Insomnia
Lack of energy
Agitation
Loss of interests
Feeling guilt
Suicidal ideation
Lithium
Therapeutic serum concentration
For acute mania:1-1.5 meq/L
For maintenance : 0.6-1.2 meq/L
Serum lithium level to be monitored once or twice a
week until dosage and serum levels are stable.
Then monthly during maintenance therapy
Symptoms of lithium toxicity begin to appear as the
blood levels greater than 1.5 meq/L
Serum level of 1-5-2: Blurred vision, ataxia, tinnitus,
persistent nausea, vomiting and diarrhea
2-3.5 meq/l: excessive output of dilute urine, increasing
tremors, muscular irritability, psychomotor retardation,
mental confusion and giddiness
>3.5 meq/l: impaired consciousness, nystagmus, seizures,
coma, MI and cardiovascular collapse, renal failure
Nursing Intervention
Clients needs to maintain a normal salt or sodium intake.
Replace water loss. Drink 8-12 glass of liquid every day.
Avoid NSAID.
Avoid caffeine.
Lithium should always be taken with food and milk to prevent
stomach upset.
Lithium should be avoided during pregnancy.
Notify if vomiting occur.
Nursing Intervention
Need regular monitoring of:
Blood level of lithium
Thyroid function (TSH)
Kidney function (GFR)
Dont discontinue the medication abruptly.
9
Carbamazepine (Tegretol)
Indication:
Treatment of epilepsy
Treatment of manic and depressive episodes.
Resistant schizophrenia
Prevention of relapse of mania and depressive episodes.
Side Effect and Management
Blood dyscrasias (leukopenia Obtain the clients baseline CBC and
platelet count
anemia, thrombocytopenia) Observe clients for signs of bruising and
bleeding of gums.
Sign of flu
Hypersensitivity with MOI
Hypo-osmolarity (promotes Monitor serum sodium
secretion of ADH, which inhibits Monitor clients for edema
water excretion by the kidneys
and places clients with heart
failure at risk for fluid
overload
Side Effect and Management
Skin Allergies Advise clients to sunblock
Avoid direct exposure to sun
Nausea, Vomiting, Advise clients to take medication with food
Fatigue,Abdominal pain, Monitor liver function
and Jaundice Administer the lowest effective dose
Valporic Acid (Depakin)
Used in treatment of epilepsy, bipolar mania
Side Effect and Management
Diarrhea, Nausea, Vomiting. Take with food or milk
Eat frequent, small meals
Hormonal disturbances Arrange for counseling for women of
(increased testosterone childbearing age.
production in females and
Use contraceptive techniques at all
menstrual irregularities). times.
Do not discontinue this drug abruptly or
change dosage.
Side Effect and Management
Hair loss, weight gain, Assist clients to follow a healthy diet
infections. and Regular exercise.
Monitor sign of infection
Avoid alcohol and sleep-inducing.
Dizziness, Drowsiness,
Tremor, Headache seeing Have frequent checkups including
blood tests.
double memory problems.
Monitor vital sign
