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Mood Stabilizing Agents

By :-Basma mustafa abukhadeir

Mood Stabilizing Agents


Mood stabilizers are medicines used in the treatment of bipolar disorder, where a persons mood changes from a depressed feeling to a high manic feeling, These drugs can help reduce mood swings and prevent manic and depressive episodes.

Mania
Mania can be a symptom of a medical condition, a psychological condition or can be triggered by substance abuse. Some features of mania include: extreme elevated mood or euphoria grandiosity high energy irritability rapid speech racing thoughts decreased sleep impulsiveness risky sexual behaviors excessive spending

Depression
2- Depression is a "whole-body" illness, involving your (body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things). People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Classic Mood Stabilizer:


* Antimanic : Lithium Carbonate (Carbolith), first and typical mood stabilizer * Anticonvulsants: Carbamazepine (Tegretol), anticonvulsant and mood stabilizer Oxcarbazepine (Trileptal), anticonvulsant and mood stabilizer Valproic acid, and Valproic acid salts (Depakine, Depakote), anticonvulsant and mood stabilizer Lamotrigine (Lamictal), atypical anticonvulsant and mood stabilizer Gabapentin, atypical GABA-related anticonvulsant and mood stabilizer Pregabalin, atypical GABA-ergic anticonvulsant and mood stabilizer Topiramate, GABA-receptor related anticonvulsant and moodstabilizer Olanzapine, atypical antipsychotic and mood stabilizer

Classic Mood Stabilizer:


* Calcium channel blocker : Verapamil (isoptin)
* Antipsychotic : Olanzapine (zyprexa)

lithium
Mechanism of action : Not fully understood , but may enhance reuptake of norepinephrine and serotonin , decreasing the level in the body , resulting in decreased hyperactivity ( may take 1-3 wks for symptoms ) Lithium has been the predominant treatment for mania .

Getting the right dose


Its based on how much of the drug is in your blood and how you respond to treatment. This means that the dose differs for everyone who takes it. Blood samples are taken regularly to make sure that the dose is neither too high nor too low On days that you are scheduled to have your blood level tested, wait until after the test to take your morning dose to avoid inaccurate results.

lithium overdose
The margin between the therapeutic and toxic levels of lithium carbonate is very narrow , the usual ranges of therapeutic serum concentrations are : For acute mania : 1,0 to 1,5 mEq/L For maintenance : 0,6 to 1,2 mEq/L Serum lithium levels should be monitored once or twice a week after initial treatment until serum level are stable , then monthly during maintenance .

Lithium toxicity
Symptoms of lithium toxicity begin to appear at blood level greater than 1,5 mEq/L , symptoms include : 1- at serum level of 1,5 to 2,0 : blurred vision , tinnitus , nausea , vomiting , sever diarrhea 2- at serum level of 2,0 to 3,5 : excessive output , increase tremors , psychomotor retardation , confusion 3- at serum level above 3,5 : impaired consciousness , seizures , coma , oliguria , anuria , cardio vascular collapse .

Signs of lithium overdose


Lithium blood levels can increase to dangerous levels when a person becomes severely dehydrated. Remember to drink eight to 12 cups of fluid per day, especially when its hot or when youre exercising. Severe vomiting, diarrhea or a fever can also cause dehydration. If you have these symptoms, stop taking lithium and see your doctor as soon as possible. Changing the amount of salt you use can also affect lithium levels: avoid low- or no-salt diets. Signs that the amount of lithium in the body is higher than it should be include severe nausea, vomiting and diarrhea, shaking and twitching, loss of balance, slurred speech, double vision and weakness.

Signs of lithium overdose


In addition to : Taking mood stabilizers may reduce your interest in Sex and some men who take lithium report a decreased ability to maintain an erection or to ejaculate . In women, mood stabilizers may cause changes in the menstrual cycle

Note !!!
1- pre assessment of renal functioning should be performed 2- Lithium is similar to sodium 3- Ensure that client consumes adequate fluid intake 2,500 to 3,000 ml of fluid per day 4- Accurate records of intake and output .

Anticonvulsants
anticonvulsants used in the treatment of mood disorders. Reduces neuronal activity by: -Reducing flux of ions through voltage-gated ion channels, such as Na+, K+, Ca2+ -Enhancing inhibitory neurotransmission with GABA, by increasing its synthesis,

Medication Anticonvulsants Clonazepam (Klonopin) Carbamazepine (Tegretol) Valproic acid (Depakene; Depakote) Gabapentin (Neurontin) Lamotrigine (Lamictal) Topiramate (Topamax)

Side Effects

Nursing Implications 1. May give with food or milk to minimize GI upset.

1. Nausea/vomiting
2. Drowsiness; dizziness 3. Blood dyscrasias 4. Prolonged bleeding time (with valproic acid)

2. Ensure that client understands the importance of regular blood tests while receiving anticonvulsant therapy.
3. Ensure that platelet counts and bleeding time are determined before initiation of therapy with valproic acid. Monitor for spontaneous bleeding or bruising.

5. Risk of severe rash

Medication Calcium Channel Blocker ( calan : isoptin )

Side Effects 1. Drowsiness; dizziness

Nursing Implications

1. Ensure that client does not operate dangerous 2. Hypotension; bradycardia machinery or participate in activities that require alertness. 3. Nausea 4. Constipation 2. Take vital signs just before initiation of therapy and before daily administration of the medication. Physician will provide acceptable parameters for administration. Report marked changes immediately. 3. Encourage increased fluid (if not contraindicated) and fiber in the diet.

Medication Antipsychotics Olanzapine (Zyprexa)

Side Effects 1. Drowsiness; dizziness 2. Dry mouth; constipation 3. Increased appetite; weight gain

Nursing Implications 1. Ensure that client does not operate dangerous machinery or participate in activities that require alertness. 2. Provide sugarless candy or gum, ice, and frequent sips of water. Provide foods high in fiber; encourage physical activity and fluid if not contraindicated.

3. order calorie controlled diet; provide opportunity for physical exercise; provide diet and exercise instruction.

Summary
Mood stabilizer drugs are used primarily to treat bipolar disease ( mania , depression ) , lithium has been predominant treatment for mania , other major categories include anticonvulsants , those medications should be given carefully to prevent any complication or side effects especially the lithium , and detect any abnormality to provide suitable and quick intervention to the client

Referances
* psychiatric mental health nursing 5 edition ,, moher
*Manual of psychiatric nursing care