Management of Adverse Effects of Mood Stabilizers

Abstract

Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

“…Carbamazepine is often associated with reduced levels of estradiol, progesterone and testosterone, and may cause hypogonadism, amenorrhea and decreased sexual function and sexual desire 129,142 . It may also increase sexual hormone-binding globulin (SHBG) concentration, leading to diminished bioactivity of testosterone and estradiol, and consequently reduced libido and erectile dysfunction 143 .…”

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

“…For safety reasons it has been recommended that inhaled loxapine should be restricted to a single dose in 24 hours and needs to be subject to a Risk Evaluation and Mitigation Strategy program (Citrome, 2012; Kwentus et al, 2012). In Europe, 2 doses are allowed (the second must be given 2 hours after the initial inhalation) (Popovic et al, 2015). …”

“…While most authors argue that lithium is neuroprotective, a neurotoxic effect is also possible in the long term, even at therapeutic levels, especially in combination with antipsychotics (Fountoulakis et al, 2008b). Comprehensive guidelines concerning lithium treatment and optimal therapeutic serum levels are available and should be applied (Malhi et al, 2011), and a recent review provides up-to-date information on its safety (Murru et al, 2015). …”

Selenium prevents lithium accumulation and does not disturb basic microelement homeostasis in liver and kidney of rats exposed to lithium

“…However, despite beneficial action, the therapy may carry side-effects, affecting both life conditions and compliance of patients in a considerable way. Lithium's side-effects include hypercalcaemia, gastrointestinal, dermatological, cardiovascular, renal, as well as thyroid and parathyroid disorders [2,7,8,9,10,11,12]. Research has revealed its harmful influence on the functions of key organs, including liver and kidney [2,10,13,14] with the latter being particularly vulnerable [3,15,16].…”