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Dolphin Psychiatry

Mood Stabilisers

Psychiatry notes arranged as a calm, searchable reference library.

Psychiatric medications that suppress major mood swings (such as found in manic-depressive disorders and certain personality disorders), mood stabilisers are almost always anticonvulsants, the notable exception being lithium.

Carbamazepine

Brand names
Biston®, Calepsin®, Carbatrol®, Epitol®, Equetro®, Finlepsin®, Sirtal®, Stazepine®, Tegretol®, Telesmin®, Timonil®
Formula
C15H12N2O
Half life
~ 25 to 65 hours (vague figure)
Single unit dose
Unknown
Recommended outpatient dose
Unknown
Maximum outpatient dose
Unknown

Interestingly, this drug renders birth control pills useless by lowering the levels of estrogen produced by them. It was first marketed as an anticonvulsant in the UK in 1965; the USA followed suit in 1974.

Common side effects include malco-ordination, drowsiness and nausea; certain preparations when taken regularly can also vastly reduce alcohol tolerance.

Gabapentin

Brand names
Neurontin®
Formula
C9H17NO2
Half life
~ 5 to 7 hours
Single unit dose
Unknown
Recommended outpatient dose
Unknown
Maximum outpatient dose
Unknown

Well tolerated with few side effects (mostly), gabapentin was synthesised to resemble the chemical structure of GABA. It is primarily used to treat epilepsy but is also used in the treatment of bipolar disorder, painful neuropathies, and anxiety disorders. It is somewhat controversial as a treatment for bipolar disorder as some high profile research has indicated that the drug is no more effective than placebo.

Lamotrigine

Brand names
Lamictal®
Formula
C9H7Cl2N5
Half life
24 to 34 hours (vague figure)
Single unit dose
Unknown
Recommended outpatient dose
100mg per day [Verified]
Maximum outpatient dose
500mg per day [Verified]

An anticonvulsant drug used to treat bipolar disorders and epilepsy, lamotrigine is the only anticonvulsant mood stabilising drug to tackle both the manic and the depressive sides of a bipolar disorder; it is also the first drug to be approved for the treatment of bipolar I since the introduction of lithium.

Antidepressant effects kick in at doses of 100mg a day and mood stabilising effects generally bite at between 100mg to 200mg per day (epilepsy is treatable with between 300mg to 500mg per day). Common side effects include insomnia, dizziness and headaches; nursing whilst on this drug is not recommended.

Levetiracetam

Brand names
Keppra®
Formula
C8H14N2O2
Half life
~ 6 to 8 hours
Single unit dose
Unknown
Recommended outpatient dose
500mg per day [Verified]
Maximum outpatient dose
1.5g per day [Verified]

I have no information on this drug at this time.

Lithium

Brand names
Carbolith®, Cibalith-S®, Duralith®, Eskalith®, Lithane®, Lithizine®, Lithobid®, Lithonate® and Lithotabs®
Formula
Lithium Carbonate is Li2CO3, Lithium Citrate is Li3C6H5O7, Lithium Sulphate is Li2SO4 and Lithium Oxybutyrate is C4H9LiO3
Half life
Varies
Single unit dose
Varies
Recommended outpatient dose
Varies
Maximum outpatient dose
Varies

Administered as one of a number of salts, lithium is primarily used as a mood stabiliser to control the manic phase of bipolar disorders. It can additionally, however, be used to augment the effectiveness of antidepressants and even antipsychotics (a mixture of clozapine and lithium, for instance, is often prescribed for patients who show little or no improvement when on more standard treatments). Lithium is thought to act by reducing the amount of the monoamine neurotransmitter noradrenaline being produced and by increasing the amount of the monoamine neurotransmitter serotonin being produced.

The drug was first considered as a treatment for manic illnesses in 1949 and was initially thought of as a tranquilliser. Although it s a strong medication and one that is often well responded to, it must be mentioned that patients on this drug will require regular blood tests and will be subject to close scrutiny, as even mild overdoses can cause problems (the most therapeutic dose is only just south of the maximum safe dose). However, don't let this put you off it as a treatment - if it were extremely dangerous, it wouldn't be available for prescription. The drug does, however, have a flattening effect, usually temporary - in essence, you'll calm down but your enthusiasm for things in general my ebb for a while.

Oxcarbazepine

Brand names
Trileptal®
Formula
C15H12N2O2
Half life
~ 1 to 5 hours (vague figure)
Single unit dose
Unknown
Recommended outpatient dose
600mg per day [Verified]
Maximum outpatient dose
2.4g per day [Verified]

A derivative of carbamazepine, oxcarbazepine boasts a far better side effects profile than it's parent drug; the only chemical difference is the addition of one oxygen atom per molecule. It's an anticonvulsant and mood stabilising drug and is primarily used in the treatment of bipolar disorders and epilepsy.

First introduced to Denmark in 1990 as an anticonvulsant, typical side effects can include blurred vision, fatigue, nausea, vomiting and even - rarely - hyponatremia.

Phenytoin

Brand names
Dilantin®, Dilantin Infatabs®, Dilantin Kapseals®, Epanutin®, Phenytek®
Formula
C15H12N2O2
Half life
~ 22 hours
Single unit dose
Unknown
Recommended outpatient dose
200mg per day [Verified]
Maximum outpatient dose
500mg per day [Verified]

I have no information on this drug at this time.

Sodium Valproate

Brand names
Convulex®, Depakene®, Depakine®, Depakine Chrono®, Epiject®, Epilim®, Epilim Chrono®, Epilim EC200®, Epilim Intravenous®, Epival®, Orfiril®, Orfiril IV®, Orlept®, Orlept Sugar Free®
Formula
C8H15NaO2
Half life
~ 9 to 19 hours
Single unit dose
Unknown
Recommended outpatient dose
1g per day [Verified]
Maximum outpatient dose
2.5g per day [Verified]

This anticonvulsant drug is also frequently used as a mood stabiliser, limiting manic episodes and, to a lesser extent, depressive episodes.

Tiagabine

Brand names
Gabitril®
Formula
C20H25NO2S2
Half life
~ 7 to 9 hours
Single unit dose
Unknown
Recommended outpatient dose
30mg per day [Verified]
Maximum outpatient dose
45mg per day [Verified]

I have no information on this drug at this time.

Topiramate

Brand names
Topamax®
Formula
C12H21NO8S
Half life
~ 19 to 23 hours (vague figure)
Single unit dose
Unknown
Recommended outpatient dose
100mg [Verified]
Maximum outpatient dose
400mg [Verified]

Used to treat epilepsy in both children and adults, topiramate can also be used to treat migraines. It can also be used in the treatment of bipolar disorder, although this capacity is somewhat controversial and remains off-label.

Common side effects include feelings of pins and needles and an altered sense of taste.

Valproate Semisodium (Divalproex Sodium)

Brand names
Depakote®, Depakote ER®, Epival®
Formula
C16H31NaO4
Half life
~ 6 to 16 hours
Single unit dose
Unknown
Recommended outpatient dose
500mg per day [Not Verified]
Maximum outpatient dose
1,000mg per day [Not Verified]

A compound of valproic acid and sodium valproate, valproate semisodium is an anticonvulsant drug.

Valproic Acid

Brand names
Unknown
Formula
C8H16O2
Half life
~ 9 to 16 hours (vague figure)
Single unit dose
Unknown
Recommended outpatient dose
Unknown
Maximum outpatient dose
Unknown

Used as a treatment for schizophrenia, migraines, epilepsy and bipolar disorders, valproic acid sports dyspepsia and/or weight gain as the main side effect symptoms.

Zonisamide

Brand names
Exegran®, Zonegran®
Formula
C8H8N2O3S
Half life
~ 63 hours
Single unit dose
Unknown
Recommended outpatient dose
300mg per day [Verified]
Maximum outpatient dose
500mg per day [Verified]

I have no information on this drug at this time.

Important: This site reformats the supplied source notes and does not independently verify or update their medical claims. It is for reference/educational use only and is not a substitute for current clinical guidance or professional medical advice.