Chapter 16: Antimanic Drugs & Mood Stabilizers

Antimanic Drugs & Mood Stabilizers identifies lithium as the gold standard in psychopharmacology, detailing its function as a naturally occurring element that substitutes for sodium to normalize the sodium-potassium ATPase pump and stabilize second messenger systems. The text explains how lithium regulates intracellular signaling to inhibit the release and facilitate the reuptake of key neurotransmitters such as norepinephrine, serotonin, and dopamine, effectively reducing the synaptic hyperactivity associated with mania. Significant attention is given to the pharmacokinetics of lithium, including its narrow therapeutic index of 0.6 to 1.2 mEq per L, and the critical need to monitor for toxicity signs like coarse tremors, confusion, and seizures which typically appear when levels are greater than 1.5 mEq per L. The summary also covers essential nursing implications, such as maintaining consistent dietary sodium and fluid intake to prevent adverse interactions with diuretics or NSAIDs, which can dangerously elevate lithium levels. Beyond lithium, the chapter extensively reviews anticonvulsants used as mood stabilizers, particularly divalproex and other valproates, which are effective for acute mania and work by increasing inhibitory GABA activity and suppressing sodium influx to prevent neuronal "kindling". Other agents discussed include carbamazepine, which requires monitoring for agranulocytosis, and lamotrigine, which carries a risk for severe dermatological reactions like Stevens-Johnson syndrome. Finally, the text outlines the role of atypical and traditional antipsychotics in managing acute mania and emphasizes patient education regarding compliance, side effect management, and the risks of teratogenicity during pregnancy.