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Ethical Issues In Modern Medicine: Contemporary Readings in Bioethics Bonnie Steinbock, Alex John London, John Arras



Refusing Care: Forced Treatment and the Rights of the Mentally Ill Elyn R. Saks

Elyn Saks, who herself battles with schizophrenia, is a writer, professor, and spokesperson for schizophrenia. Saks, in her book, Refusing Care, helps the reader to appreciate that, even in serious situations, the patient still has the right to refuse certain types of medical care, in this case drug treatment. She feels that it would be rare situations where forced drug treatment would be appropriate. She is an elequent and dignified, humorous speaker. Her ideas on the subject are worth taking note of.


Page updated: January 25, 2012



Mood Stabilizers: Uses, Effects and Side Effects


Bipolar disorder treatment. Lithium treatment, lithium effects,
information, side effects.
Psychiatric Drugs-Types (on-site link)


 
Lithium Treatment- One of the first drugs to be used as a mood stabilizer for manic depression.
Lithium carbonate, one of several lithium compounds used as a mood stabilizer for manic depression or bipolar disorder.


Lithium, in the salt family, is also a powerful mood altering drug. While a naturally occurring compound, when used as a mood stabilizer, it can have strong and multiple side effects.


Regular blood testing is necessary when taking lithium and the levels of the drug need to be closely monitored. It is used in treating bipolar disorder and some severe depressions, although it's effectiveness is said to be very variable in treating depressions.



Uses of mood stabilizers: Mania and hypomania. (Hypomania-close to mania).
The first mood stabilizer to be used was lithium, and it is the only drug that was developed specifically for use in bipolar disorder. It was first approved for use in treating mood swings by the FDA in the 1970s.

Most the other drugs classified as mood stabilizers are medications that were first used to treat seizure disorders, such as epilepsy. They are known as "anticonvulsants," since they are designed to inhibit or reduce the frequency of seizures. Interestingly, they also help stabilize mood swings.

Some heart-related medications called calcium channel blockers are being studied for use in treating bipolar disorder as mood stabilizers.

Bipolar disorder treatment, commonly includes mood stabilizers. Antipsychotics and antidepressants are also sometimes used along with a mood stabilizer.


Commonly Used Mood Stabilizers: Generic name: carbamazepine
Trade name Tegretol
Generic: valporate
Trade name: Depakote

Mood Stabilizers uses and side effects:
Bipolar disorder, especially manic episodes. Tegretol-neurotoxic side effects have been noted, including unsteady gait, tremor, ataxia, and increased restlessness.

Depakote: fewer side effects than lithium, but can be sedating. Depakote is used much more frequently than lithium today, however, it carries a 2-3x higher risk of suicidality than lithium.


Lithium - Side Effects:
Lithium, a mainstay in the treatment of bipolar disorder, has been reported to induce adverse effects in 35%?93% of patients who take it, and these adverse events often lead to noncompliance.

The side effects most frequently reported were:

  • Polyuria-polydipsia syndrome, which affected 36 (60%) of 60 patients.
  • Tremor (54% men v. 26% women, p < 0.05)
  • Weight gain during the first year (47% women v. 18% men, p < 0.05)
  • Clinical hypothyroidism (37% women v. 9% men, p < 0.05)

  • Source: Journal of Psychiatry and Neuroscience. 2002.

    Other "real life" side effects for lithium are reported from numerous sources as follows:

  • slow verbalization
  • feeling somewhat "detached"
  • feeling detached from my own voice
  • emotionally detached
  • not feeling yourself
  • tiredness
  • tremors
  • lithium [emotional] flatness

    The publication, Mental Health Medications (off-site link), by the National Institute of Mental Health, U.S. Department of Human Health Services, lists the following side effects for lithium treatment for bipolar disorder, stating,

    Lithium can cause several side effects, and some of them may become serious. They include:

  • Loss of coordination
  • Excessive thirst
  • Frequent urination
  • Blackouts
  • Seizures
  • Slurred speech
  • Fast, slow, irregular, or pounding heartbeat
  • Hallucinations (seeing things or hearing voices that do not exist)
  • Changes in vision
  • Itching, rash
  • Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.
  • Side effects for lithium are usually more intense in the first months and gradually improve slightly, although, persons who have been on lithium for many years, still describe some of the emotional detachment and other side effects listed here.



    Notes on lithium side effects from Depression Forum:

    "....i was wondering as it's a mood stabilizer, if it blunts higher levels of mood...?...i don't ever get excited or highly aroused etc."

    "...my emotions were flat ALL the time. I hated that. It did stabilize me and I thank God for that but I wanted to feel a little too." L. (www.depressionforums.org)


    Additional side effects or complications with lithium use:

    "Lithium has been associated with birth defects."
    Stopping after finding out one is pregnant "may be too late to prevent a birth defect." (Mondimor, p.91).

    "A noticeable dulling of mental functioning and coordination," is listed as a major side effect. (Ibid, p. 92).

    "Patients often complain that their ability to memorize and learn is affected and that they have a difficult-to explain sense of mental sluggishness."(Ibid, p. 92).

    From book: Bipolar - A Guide for Patients and Families by Francis Mondimore.


    References for Mood Stabilizers and Lithium page


    1. Lithium side-effects and predictors of hypothyroidism in patients with bipolar disorder: sex differences>. (March 27, 2002). Chantal Henry Journal of Psychiatry and Neuroscience. Service Universitaire de Psychiatrie, CH Charles Perrens and INSERM U-394, Neurobiologie Intgrative, Bordeaux, France. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=161639

    2. Mental Health Medications (off-site link), (2008). National Institute of Mental Health, U.S. Department of Human Health Services.

    3. Mondimore, Francis Mark, M.D., (2006). Bipolar - A Guide for Patients and Families 2nd Edition. Baltimore: The John Hopkins University Press.

    4. Read, K., Purse, M. Speaking from Experience - Lithium. (June 18, 2006). About.com. http://bipolar.about.com/cs/experience/a/sfe_lithgensfx.htm