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Mood Stabilizers
Antidepressants
100

What are the therapeutic serum levels of lithium, and what is the toxic range?

The therapeutic serum level of lithium is between 0.6–1.2 mEq/L. Levels above 1.5 mEq/L are considered toxic, with severe toxicity occurring above 2.0 mEq/L.

100

What are the primary classes of antidepressants?


  1. Selective Serotonin Reuptake Inhibitors (SSRIs)
  2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
  3. Tricyclic Antidepressants (TCAs)
  4. Monoamine Oxidase Inhibitors (MAOIs)
  5. Atypical Antidepressants (e.g., bupropion, mirtazapine)
200

Which factors increase the risk of lithium toxicity?

  • Dehydration
  • Renal impairment (since lithium is excreted by the kidneys)
  • Use of drugs like NSAIDs, ACE inhibitors, and diuretics (especially thiazides), which reduce lithium clearance.
  • Low sodium intake or excessive sodium loss (e.g., sweating, diarrhea).
200

How long does it typically take for antidepressants to show therapeutic effects?

Antidepressants typically take 2 to 4 weeks to start showing noticeable clinical effects, although full therapeutic benefits may take up to 6-8 weeks.

300

What are the major side effects of valproic acid?

  • Weight gain
  • Tremor
  • Hepatotoxicity (monitor liver function)
  • Pancreatitis
  • Thrombocytopenia (low platelet count)
  • Teratogenicity (neural tube defects if taken during pregnancy)
  • GI disturbances (nausea, vomiting)
300

What is serotonin syndrome, and what causes it?

Serotonin syndrome is a potentially life-threatening condition caused by excess serotonin in the CNS. It can result from SSRI overdose or combining SSRIs with other serotonergic agents (e.g., MAOIs, triptans). Symptoms include agitation, hyperreflexia, tremors, hyperthermia, and altered mental status.

400

What is the role of lamotrigine in mood stabilization?


Lamotrigine is primarily used in the maintenance phase of bipolar disorder, particularly to prevent depressive episodes. It works by inhibiting voltage-gated sodium channels, which reduces glutamate release and stabilizes mood.

400

Why are TCAs dangerous in overdose?

TCAs are highly cardiotoxic in overdose, leading to QT prolongation, arrhythmias, and potentially fatal outcomes. They also have a narrow therapeutic index, increasing the risk of overdose.

500

What are the key considerations when treating a pregnant patient with mood stabilizers?

  • Lithium: Risk of Ebstein’s anomaly (congenital heart defect).
  • Valproic acid: High risk of neural tube defects (e.g., spina bifida).
  • Carbamazepine: Risk of neural tube defects and craniofacial abnormalities.
  • Lamotrigine: Generally safer, but close monitoring is still required.
500

Name five commonly prescribed SSRIs and their indications.

  • Fluoxetine (Prozac) – MDD, OCD, panic disorder, bulimia
  • Sertraline (Zoloft) – MDD, PTSD, OCD, social anxiety disorder
  • Citalopram (Celexa) – MDD
  • Escitalopram (Lexapro) – MDD, generalized anxiety disorder (GAD)
  • Paroxetine (Paxil) – MDD, anxiety disorders, PTSD, OCD