Mood Stabilizers: Side Effects, Contraindications, and Interactions

The key mood stabilizers used in clinical practice are a heterogeneous group of medications with multiple disparities. Included among this group are lithium, certain antiepileptic drugs such as carbamazepine, lamotrigine, and valproate, as well as certain atypical antipsychotics such as asenapine, olanzapine, quetiapine, and risperidone. The side effect profile is varied, but these medications can have an impact on the central nervous system as well as the cardiac, gastrointestinal, endocrine, renal, and the hematopoietic systems. Sexual and allergic side effects are also of significant importance. Among the mood stabilizers, valproate treatment seemingly carries the highest risk for birth defects. Other specific side effects of clinical importance include lithium toxicity which can lead to ataxia, rigor, cerebral seizures, and shock; decreased bone marrow function under carbamazepine treatment; and Stevens-Johnson syndrome and Lyell’s syndrome induced by carbamazepine or lamotrigine. In addition to this, it is important to be aware of the risk of liver failure and pancreatic damage caused by valproate and weight gain and metabolic disturbances associated with atypical antipsychotics such as olanzapine and quetiapine. Having a pre-existing condition which affects any of the organs listed above puts the patient at higher risk of developing these side effects. Hence, this would be one of the major contraindications. Conditions involving the organs which metabolize the medication in question can also present as a contraindication, for example, if the condition involves the liver or kidneys. In order to gauge potential interactions, one must take into account the metabolization and elimination of the medication, together with the medication’s potential to induce or inhibit cytochrome P450 isoenzymes and glucuronosyltransferases.