Antimanic agents, or mood stabilizers, control manic episodes in bipolar disorder by stabilizing brain activity.
Definition of Mood Stabilizers:
- Drugs that stabilize mood in bipolar disorder, preventing both manic and depressive episodes.
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Major Agents:
-
Lithium
- Mechanism: Unclear; inhibits inositol monophosphatase, reduces second messenger activity
- Therapeutic index is narrow
-
Anticonvulsants as Antimanic Agents:
- Valproic acid: increases GABA availability; useful in acute mania
- Carbamazepine: sodium channel blocker; helpful in rapid-cycling bipolar disorder
- Lamotrigine: stabilizes mood, particularly effective for bipolar depression
-
Atypical Antipsychotics
- Used for acute mania or as adjuncts in maintenance therapy
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Therapeutic Uses:
- Bipolar disorder (acute mania and maintenance)
- Adjunct in unipolar depression
Side Effects of Mood Stabilizers:
- Lithium:
- Tremor, hypothyroidism, nephrogenic diabetes insipidus
- Teratogenic (Ebstein anomaly)
- Toxicity with NSAIDs, ACE inhibitors, diuretics
- Valproate: Hepatotoxicity, neural tube defects
- Carbamazepine: Agranulocytosis, hyponatremia
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Pharmacokinetics:
- Lithium: Excreted by kidneys; plasma monitoring required
- Anticonvulsants: Hepatic metabolism
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