Antipsychotic Mood Stabilizers

Antipsychotic Mood Stabilizers

by | Apr 21, 2022 | aripiprazole, Bipolar Disorder, Medications, quetiapine

The Good, the Bad, and the Ugly

 

THE GOOD

Originally developed for hearing voices in schizophrenia, but so many other uses!

Great for bipolar mania

Most Antipsychotic Mood Stabilizers (AMS) treat bipolar depression as well

Good addition to antidepressants for moderate to severe unipolar depression

Safe for kidneys and thyroid

Most are generic

Taken once daily

Most help you sleep! (But some give you more energy without the sedation)

Not a lot of medication interactions

Yearly blood tests to check cholesterol and blood sugar

 

THE BAD

Often cause sleepiness (this can be a good thing!)

Can increase blood cholesterol (needs to be checked annually)

Can increase blood sugar and the risk for diabetes (needs to be checked annually)

Mild to moderate weight gain is possible/common

 

THE UGLY

Uncommon: AKATHISIA

  • “Restless legs all over my body”
  • Not fatal, but uncomfortable
  • Can be easily reversed with beta blockers, a blood pressure medication

Very rare: TARDIVE DYSKINESIA

  • Involuntary muscle movements, usually of the face or tongue
  • This is more common at higher doses of AMS
  • 1/3 of the time, it does not go away
  • There are several new medications on the market that are good at treating this if it persists after the medication is stopped
  • Seroquel (quetiapine) has the lowest risk
Mood Stabilizers for Bipolar Disorder

Mood Stabilizers for Bipolar Disorder

by | Apr 21, 2022 | aripiprazole, Bipolar Disorder, lithium, Medications, quetiapine, valproate

If you have highs that last for days to weeks as well as depression, talking to your psychiatrist about the possibility of Bipolar Disorder type I or Bipolar Disorder type II might be a good idea. Bipolar disorder medication is treated inherently differently than unipolar depression, where you only have low moods without the highs. Bipolar disorder requires a mood stabilizers. usually, antidepressants like Prozac can have negative effects effects on mood. First line treatment is a mood stabilizer, and only at that point could your psychiatrist consider adding an antidepressant for anxiety or medication for ADHD.

 

Common Mood Stabilizers

Common Mood Stabilizers - Lithium, Valproate, Seroquel and Abilify

Getting the diagnosis of bipolar disorder can be quite disorienting and fear-inducing. However, there are many successful programmers, attorneys, and even physicians with bipolar disorder. Additionally, there is a connection between bipolar disorder and creativity that is undeniable, even though it has yet to be fully explored. Read The Midnight Disease by neurologist Dr. Alice Flaherty of the Harvard Medical School to learn more.

Treating bipolar disorder is one of the best parts of my job, because while it can be debilitating, with the right medication people feel better and quickly become more successful, effective, and happier. I like being able to help someone find their true self again.

Lamotrigine (Lamictal)

Lamotrigine (Lamictal)

by | Jul 20, 2021 | Bipolar Disorder, lamotrigine, Medications

Snapshot of Benefits, Risks, and Possible Side Effects

USES

  • Introduced as an anti-seizure medication in 1994

  • Approved for Use in Bipolar Depression in 2003
  • Prevention and treatment of depressive episodes in: 
    • Bipolar I Disorder
    • Bipolar II Disorder
  • Off-Label use:
    • Treatment of Resistant Unipolar Depression
    • Treatment of Borderline Personality Disorder

PROS

  • Effectively prevents future depressive episodes
  • Relief from depressive episodes
  • Can be taken in conjunction with other medications for Bipolar Disorder
  • Minimal if any sexual side effects
  • Minimal if any effects on weight
  • No blood tests required routinely
  • No metabolic side effects (no change in blood sugar or cholesterol)

CONS

Mild/Common

  • Nausea
  • Benign, mildly itchy Rash (3%)

Rare/Severe (contact your doctor!)

  • Rash
  • Involving mucus membranes & associated with fever
  • Chance is 1 in 4000 people who take the medication
  • Happens slightly more often in people of Asian heritage
  • Only reported during the 30-60 days following lamotrigine initiation or dose increase.
  • Increased risk if you do not titrate the dose up slowly or if restarting at a high dose after 4-5 days of not taking the lamotrigine.
  • Heart palpitations
  • Allergic reaction involving swelling of tongue, lips, or throat
  • Increase in anxiety and/or suicidal ideation
Lamotrigine (Lamictal)

Lamotrigine History and Use

Lamotrigine (Lamictal) is a medication that has a variety of uses: the drug was introduced in 1994 as an anticonvulsant and anti-seizure medication, but thereafter has also been found to be particularly effective in preventing depressive mood episodes in the treatment of Bipolar I and Bipolar II Disorder. It is important to note that lamotrigine has not been shown to reliably decrease the occurrence of manic or hypomanic episodes, and has been in some cases observed to sometimes increase their occurrence.

Lamotrigine works by inhibiting the release of glutamate (an excitatory amino acid and neurotransmitter) from cells in the brain, and by stabilizing the membranes of these cells.

Your psychiatrist might discuss the possibility of adding lamotrigine to your treatment regimen if you have recurrent depressive episodes that interfere with your daily life, or if you have not found relief from other medications to treat Bipolar Disorder. Lamotrigine can be used alone to treat bipolar disorder or in conjunction with other mood-stabilizing or antipsychotic medications. We have a list of these, with pros, cons, and side effects explained here and here on our website.

Lamotrigine (Lamictal)

Possible Side Effects

While lamotrigine has many uses and has found widespread success with many patients, there are some common as well as rare side effects to be aware of:

Lamotrigine has been linked to skin rashes ranging from mild to severe in about 3-5% of patients who have been prescribed the medication. In very rare cases, about 0.8-0.13% of patients may develop Stevens-Johnson Syndrome (SJS), in which the upper layers of the skin may peel off and must be treated in a similar fashion to a burn. The risk of this rare side effect is increased if lamotrigine has been prescribed to the patient along with other medications for Bipolar Disorder, such as valproate (brand name: Depakote). The risk of this rare side effect is also increased in patients who are children, immunocompromised, or have specific genetic profiles: your prescribing physician may request a genetic test or blood test from you to screen for possible alleles (genetic markers) that may increase the risk of these kinds of side effects before prescribing you this medication. These alleles are more common in individuals of Asian heritage.

Other possible side effects of lamotrigine can include irregular heart arrhythmias (when heartbeats come at an irregular pace), hives or itching, and the swelling of the tongue, lips, or throat. If you have been prescribed lamotrigine and observe the development of rashes, chest tightness, or trouble breathing, immediately get into contact with your prescribing physician or psychiatrist. This is even more imperative if you notice these symptoms during the first 2 months of treatment with the medication.

Advantages over other Medications

While the side effects of lamictal are important to be aware of, we cannot discount the effectiveness of the drug in giving Bipolar patients relief from recurring mood episodes, especially in comparison to other available medications. Lamotrigine, unlike many other medications commonly prescribed for Bipolar Disorder, has no effect on weight, and only needs to be taken once daily. The medication comes in a variety of immediate release and extended release formulations, and can be taken as a chewable tablet, oral capsule, or under-the-tongue dissolving tablet. The incidence of sexual side effects is essentially none.

Discussion of past medical and treatment history with your psychiatrist, and careful attention to dosages is extremely important to take into account when considering taking this medication. As changes in dosage can have a profound effect on the risk of side effects with lamotrigine, it is important to always remember to consult your prescribing physician or psychiatrist before making dosage changes.

 

References

Dulcan MK & Ballard RR. (2015). Helping Parents and Teachers Understand Medication for Behavioral and Emotional Problems, Fourth Edition.

Freerksen S, Fasano E, Grenoble S. Toxic Epidermal Necrolysis Caused by Lamotrigine: How to Counsel Patients About Risk. American Psychiatric Association Annual Conference; 2014 May 3; New York, NY. Abstract No. NR2-51