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Updated: Jun 23 2021


  • Overview
    • Psychiatric medications can be broken down into the following categories
      • antidepressants
      • antipsychotics
      • mood stabilizers
        • include lithium
      • anxiolytics
  • Mechanism
    • Mood stabilizer
    • Mechanism
      • unknown
      • may be related to inhibition of phosphoinositol recycling in neurons
  • Indications
    • Clinical use
      • mood disorders
        • bipolar disorder
          • for acute treatment of mood episodes and maintenance therapy (prevention of future episodes)
        • major depressive disorder (MDD)
          • adjunctive treatment for some patients who have failed treatment with an antidepressant alone
        • reduces suicide risk in bipolar disorder and MDD
      • SIADH
  • Toxicity and Side Effects
    • Toxicity
      • very narrow therapeutic index
        • requires blood monitoring
        • toxicity may be seen at levels higher than 1.5 mEq/L
        • increased risk in patients who are volume depleted or hyponatremic
        • caution if adding hydrochlorathiazide, NSAID, or ACE-inhibitor
        • loop diuretics do not increase toxicity
      • tremor (coarse tremor indicates likely toxicitiy)
      • sedation
      • ataxia
      • acne
      • edema
      • heart block
      • exclusively excreted by the kidneys (reabsorbed at the proximal convoluted tubule with Na+) and long term use may cause a glomerulopathy
      • hyperparathroidism
      • hypothyroidism
      • polyuria
        • ADH antagonist resulting in nephrogenic diabetes insipidus
        • reason for use in SIADH
      • leukocytosis
      • teratogenesis if given in pregnancy
        • cardiac malformations including Ebstein anomaly in first trimester
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