Drug interactions mood stabilizers

Lithium is used as a mood stabilizing drug. The Li ion interacts with many nerve centers throughout the body and within the brain. Li has a high-charge density and gives up its electrons readily so it can interact with a variety of biomolecules. Scientists aren t certain how lithium functions to stabilize mood, but it s been used since the 19th century nonetheless. 

Oxcarbazepine has mood-stabilizing effects similar to those of carbamaz-epine, but with milder side effects, no autoinduction of metabolizing enzymes, and potentially fewer drug interactions. There are fewer data supporting its efficacy than there are for carbamazepine s efficacy. 

Drug-drug interactions are often more problematic with carbamazepine than other mood stabilizers. Carbamazepine increases the activity of certain liver enzymes. Because these enzymes metabolize and eliminate medications and other substances introduced to the body, carbamazepine therapy can decrease the blood level and thereby reduce the effectiveness of itself (a phenomenon called autoinduction) and other medications that are metabolized by these enzymes. It is not unusual to find that the dose of carbamazepine must be increased after several weeks, because it has increased its own elimination. Other medications may likewise be less effective. Of particular concern are the oral contraceptives, Depo-Provera, and protease inhibitors used for the treatment of HI V+ patients. Oral contraceptives often require an increase in dose. 

Whenever possible, we prefer to treat with a mood stabilizer (e.g., lithium, VPA) alone, because of their specificity for bipolar disorder and to minimize adverse effects. This is particularly true in mild to moderately severe episodes of acute mania. In addition, if the patient can benefit from a single drug during the acute episode, this would support its benefit for maintenance and prophylactic purposes. Further, monotherapy diminishes the chance for potentially significant drug interactions and reduces cost. 

Dunner DL. Drug interactions of lithium and other anti-manic/mood-stabilizing medications. J Clin Psychiatry 2003 64 Suppl 5 38-43. 

Neuroleptic drugs are often used in mood stabilizer combinations. However, there have been few controlled studies of the use of such combinations, and interactions are potentially dangerous. The advantages and disadvantages of all currently used mood stabilizer combinations have been extensively reviewed (641). Some effects are well known neurotoxicity, hypotension, somnambulistic-like events, and cardiac and respiratory arrest associated with the combination of lithium and traditional neuroleptic drugs considered as a first-line treatment for classic euphoric mania with psychotic features. 

Klonopin (clonazepam) A conunon medication used as a mood stabilizer often prescribed for the following reasons inadequate response or intolerance to antipsychotics or lithium, manic symptoms, rapid cycling of the condition, EEC abnormalities, and head trauma. The most common side effects are difficulty with balance and drowsiness. Behavioral and emotional side effects include irritability, excitement, increased anger and aggression, trouble sleeping or nightmares, and memory loss. The most serious side effect is the interaction effect if this medication is combined with alcohol or other drugs, which can result in sleepiness, unconsciousness, and death. 

Drug-drug interactions Carbamazepine and valproate The mood stabilizers carbamazepine and valproate are often used in combination with antidepressants in patients with unipolar or bipolar affective disorder. The effects of valproate and carbamazepine on the steady-state pharmacokinetics of moclobemide and two metabolites have been studied in a non-randomized crossover study in 21 patients with unipolar depression [3 ]. Valproate had no effect, but carbamazepine was associated with a 35% reduction in moclobemide AUC, a 28% reduction in C ,ax, and a 41% reduction in clearance after 4 weeks of co-administration. These changes were interpreted as being due to induction carbamazepine of the metabolism of moclobemide and its main metabolite. However, there was no concurrent loss of efficacy, throwing into doubt the clinical significance of these significant kinetic effects. 

Interactions with other drugs have been less closely studied, but anecdotal reports suggest that lithium, a drug used to stabilize mood in people with manic depression or bipolar disorder, increases the response to LSD. 

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