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Chapter 48. Mood Stabilizers

Robert A. Kowatch, M.D., Ph.D.; Arman Danielyan, M.D.
DOI: 10.1176/appi.books.9781585623921.470449

Sections

Excerpt

The mood stabilizers lithium and valproate have been used to treat children and adolescents with mood and seizure disorders for many years. Lithium was first used over 40 years ago to treat "manic-depressive" illness in children (Annell 1969). Since then, a variety of "mood stabilizing" agents have been used to treat psychiatric disorders in children and adolescents. The mood stabilizers can be divided into the traditional agents—lithium, valproate, and carbamazepine—and the newer or "novel" agents. The novel mood stabilizers include lamotrigine, oxcarbazepine, topiramate, and gabapentin (Weisler et al. 2006). These agents have migrated from pediatric neurology to child psychiatry after clinicians noticed their behavioral effects. All of these drugs have been used to treat children and adolescents with mood and/or behavior problems, and all of these agents, except lithium, are used to treat seizure disorders. Now that six atypical antipsychotics are available in the United States, these mood stabilizers are not prescribed as often as they once were. Lithium and valproate are still often used to treat bipolar disorder in children and adolescents, and the evidence base for the safety and efficacy of these two mood stabilizers as well as the newer antiepileptic agents in children and adolescents is steadily increasing (Kowatch and DelBello 2006; Pavuluri et al. 2005).

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Table Reference Number
TABLE 48–1. Management of common lithium side effects
Table Reference Number
TABLE 48–2. Management of common valproate side effects
Table Reference Number
TABLE 48–3. Mood stabilizer dosing and monitoring guidelines

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You decide to start a 16-year-old girl on lithium for treatment of hypomania associated with her bipolar II disorder. Which of the following tests does not need to be ordered?
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With the adolescent girl in the last question, you change the formulation of lithium from lithium carbonate to a slower-release preparation. For which of the following common side effects would this change have a beneficial effect?
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Which of the following baseline studies should be ordered in children and adolescents for whom valproate is to be initiated?
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