How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 48
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Mood stabilisers
What are they for?
Mood stabilisers are drugs used to help prevent mood swings (feeling ‘high’ or ‘low’) in people who suffer from
a bipolar illness (sometimes called manic depression). They include lithium carbonate (Camcolit), sodium
valproate (Epilim) and carbamazepine (Tegretol). Lithium is also used in severe, recurrent depressive illness and
in aggression. Carbamazepine and sodium valproate are also used to help control epilepsy. Carbamazepine is
also used to relieve the symptoms of trigeminal neuralgia (a painful condition of the face) and in a number of
other illnesses such as alcohol withdrawal or alcohol dependence, schizophrenia and withdrawal from
benzodiazepines.
Side-effects
Common side-effects
• Lithium: nausea, diarrhoea, metallic taste in the mouth, weight gain, increased thirst, difficulty in
concentrating.
• Carbamazepine: drowsiness, dizziness, stomach upset, visual symptoms (eg seeing double).
• Sodium valproate: nausea and vomiting, sedation, diarrhoea/nausea.
Rare but important side-effects
All three drugs can cause serious disorders. A range of blood tests is required for monitoring.
• Lithium: blurred vision, shaking and trembling, confusion, slurred speech, nausea and vomiting, diarrhoea,
skin rashes. Advise the patient to stop taking the medication, to drink water and to see the doctor immediately.
• Carbamazepine: leucopenia, aplastic anaemia and agranulocytosis. Advise patients to report any symptoms
of fever, rash, sore throat, infections, mouth ulcers, easy bruising, paleness of skin, weakness, bleeding or
small purple spots on the skin.
• Sodium valproate: rash, impaired platelet function (patient bruises without reason and bleeds easily),
impaired liver function (the patient feels sleepy, is sick, loses appetite, the skin may look yellow). Stop taking
the medication and see the doctor immediately.
Important notes about mood stabilisers
• It is essential that these drugs are taken regularly. If lithium is stopped suddenly, there is a very high chance
that the illness will return. If the patient misses several doses, they may need a new blood test to check their
blood levels. If carbamazepine or sodium valporate is being given to help control fits or blackouts, missing a
dose can cause the fits to return.
• If the patient does not turn up to collect their medication, seek them out and ask how they are. Ask the staff
too. It is possible that the patient has not come to collect the medication because he/she has become more
depressed, with increased lethargy, hopelessness and an increased risk of suicide.
• If a patient misses a dose, do not give two or more doses next time, as this may increase side-effects. If a
patient misses two or more doses, refer them to a doctor for blood level checks.
• Remind the patient of the importance of reporting and responding to early symptoms of lithium toxicity. Make
sure he/she has a copy of the information sheet on lithium toxicity (it is on the disk ). The most common
cause of lithium toxicity is dehydra tion, which may occur during hot weather or physical exertion. Other
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