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]
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. |