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Table 1 Main classes of mood stabiliser (and alternatives to valproate in the treatment of bipolar disorder), mechanisms of action and side effects (not including foetal or maternal risks). Compiled from various sources [10, 33, 34, 91,92,93,94,95,96,97,98,99,100]

From: Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach?

Class Medication name Proposed mechanism(s) of action Side effects
Mineral Lithium Enhances serotonergic neuron activity, inhibits pAp-phosphatase enzyme, interacts with nitric oxide signalling activity Common: GI upset, fine tremor, polyuria, polydipsia, metallic taste in mouth, ankle oedema, weight gain. Chronic: renal toxicity, hypothyroidism.
Anti-epileptics Sodium valproate GABA potentiation, blocks voltage gated sodium channels, epigenetically inhibits histone deacetylase Common: GI upset, hyperammonaemia (causing nausea), weight gain, tremor, hair loss with curly regrowth.
In women: polycystic ovarian syndrome, hyperandrogenism.
Rare: fulminant liver failure.
Lamotrigine GABA potentiation, suppresses glutamate release, inhibits serotonin reuptake Common: tremors, dizziness, tiredness, loss of co-ordination, menstrual disturbance, dry mouth, sleep problems.
Carbamazepine Blocks voltage gated sodium channels Common: dizziness, diplopia, drowsiness, ataxia, nausea, headaches, dry mouth, oedema, hyponatraemia, erythematous rash, sexual dysfunction.
Rare: agranulocytosis.
Atypical antipsychotics Risperidone Dopaminergic (D1–5) receptor antagonist, serotonergic (5-HT2A/C) receptor antagonist Common: sexual dysfunction (hyperprolactinaemia).
Long term: movement disorders (e.g. tardive dyskinesia, akathisia, parkinsonism), increased risk of cardiovascular disease.
Rare: neuroleptic malignant syndrome
Olanzapine
Quetiapine
Aripiprazole Dopaminergic (D2) and serotonergic (5-HT1A) receptor partial agonist Common: weight gain, headache, agitation, insomnia, gastrointestinal effects, disinhibition.