Mood stabilizers are the cornerstones of bipolar disorder management. They each contain their unique set of monitoring parameters, including therapeutic drug monitoring. Patient specific factors, such as mood state, organ function, and pregnancy status, may help guide clinicians on selecting the appropriate mood stabilizer.

Essential Questions and References

Which tests and labs should be ordered for patients receiving mood stabilizers?

  1. Cullison SK, Resch WJ, Thomas CJ. How should you use the lab to monitor patients taking a mood stabilizer? Current Psychiatry. 2014; 13(7): 51-5. [Weblink]
  2. Finley PR. Drug Interactions with Lithium: An Update. Clin Pharmacokinet. 2016;55(8):925-41. DOI: 10.1007/s40262-016-0370-y. PubMed PMID: 26936045.
  3. Singh LK, Nizamie SH, Akhtar S, Praharaj SK. Improving tolerability of lithium with a once-daily dosing schedule. Am J Ther. 2011;18(4):288-91. DOI: 10.1097/MJT.0b013e3181d070c3. PubMed PMID: 20592663.
  4. Ketter TA. Strategies for monitoring outcomes in patients with bipolar disorder. Prim Care Companion J Clin Psychiatry. 2010;12(Suppl 1):10-6. DOI: 10.4088/PCC.9064su1c.02. PubMed PMID: 20628501; PubMed Central PMCID: PMC2902193.

How frequently should labs be ordered for patients receiving mood stabilizers?

  1. Cullison SK, Resch WJ, Thomas CJ. How should you use the lab to monitor patients taking a mood stabilizer? Current Psychiatry. 2014; 13(7): 51-5. [Weblink]

What are risks of using mood stabilizers in pregnancy?

  1. Deligiannidis KM, Byatt N, Freeman MP. Pharmacotherapy for mood disorders in pregnancy: a review of pharmacokinetic changes and clinical recommendations for therapeutic drug monitoring. J Clin Psychopharmacol. 2014;34(2):244-55. DOI: 10.1097/JCP.0000000000000087. PubMed PMID: 24525634.
  2. ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008 Apr;111(4):1001-20. [PubMed]

Do mood stabilizers differ in their abilities to treat different mood states?

  1. Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller H-J, et al.. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry. 2013;14(3):154-219. DOI: 10.3109/15622975.2013.770551. PubMed PMID: 23480132.
  2. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 5th ed. 2018;20(2):97-170. DOI: 10.1111/bdi.12609. PubMed PMID: 29536616; PubMed Central PMCID: PMC5947163.

How do we manage adverse effects associated with mood stabilizers?

  1. Kemp DE. Managing the side effects associated with commonly used treatments for bipolar depression. J Affect Disord. 2014;169 Suppl 1:S34-44. DOI: 10.1016/S0165-0327(14)70007-2. PubMed PMID: 25533913.