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Management of Adverse Effects of Mood Stabilizers

  • Bipolar Disorders (W Coryell, Section Editor)
  • Published:
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Abstract

Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

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Conflict of Interest

Jordi León-Caballero declares no conflict of interest.

Andrea Murru has received honorarium payments from Adamed, AstraZeneca, Bristol-Myers-Squibbs, Janssen, Lundbeck, and Otsuka.

Dina Popovic has received payment for manuscript preparation from Ferrer and payment for development of educational presentations from Bristol-Myers Squibb, Merck, Sharp, and Dohme, Janssen-Cilag, and Ferrer. Dr. Popovic’s work is supported by a Sara Borrell post-doctoral grant CD13/0149, provided by Carlos III Institute, Spanish Ministry of Science and Innovation.

Isabella Pacchiarotti has received honorarium payments from Adamed, Janssen-Cilag, and Lundbeck.

Diego Hidalgo has received honorarium payments from Ferrer, Lundbeck, and Jansen-Cilag.

Eduard Vieta has received consultance fees from Adamed, Almirall, AstraZeneca, Bial, Bristol-Myers Squibb, Elan, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Lundbeck, MSD, Novartis, Organon, Otsuka, Pfizer Inc, Pierre-Fabre, Roche, Sanofi-Aventis, Servier, Solvay, Takeda, Teva, UBC, and Wyeth. Dr. Vieta has also received grants from the Spanish Ministry of Health, the Spanish Ministry of Science and Education, the Spanish Ministry of Economy and Competiveness, the Stanley Medical Research Institute and the 7th Framework Program of the European Union.

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Authors and Affiliations

  1. Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

    Andrea Murru, Dina Popovic, Isabella Pacchiarotti, Diego Hidalgo & Eduard Vieta

  2. Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Barcelona, Catalonia, Spain

    Jordi León-Caballero

  3. Bipolar Disorder Unit, Hospital Clínic, c/Villaroel 170, esc. 12 pl. 0, 08036, Barcelona, Spain

    Eduard Vieta

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  1. Andrea Murru
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  2. Dina Popovic
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  5. Jordi León-Caballero
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Correspondence to Eduard Vieta.

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Murru, A., Popovic, D., Pacchiarotti, I. et al. Management of Adverse Effects of Mood Stabilizers. Curr Psychiatry Rep 17, 66 (2015). https://doi.org/10.1007/s11920-015-0603-z

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