title: Management of adverse effects of mood stabilizers.
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.
authors.affiliation: Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, AMURRU@clinic.ub.es.
authors.forename: Andrea
authors.initials: A
authors.lastname: Murru
authors.forename: Dina
authors.initials: D
authors.lastname: Popovic
authors.forename: Isabella
authors.initials: I
authors.lastname: Pacchiarotti
authors.forename: Diego
authors.initials: D
authors.lastname: Hidalgo
authors.forename: Jordi
authors.initials: J
authors.lastname: León-Caballero
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000009:adverse effects / Q000031:analogs & derivatives; D019468:Disease Management; D006801:Humans; D000077213:Lamotrigine; D018020:Lithium Compounds / Q000009:adverse effects; D000078330:Oxcarbazepine; D014227:Triazines / Q000009:adverse effects; D014635:Valproic Acid / Q000009:adverse effects
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D014227:Triazines; D002220:Carbamazepine; D014635:Valproic Acid; D000077213:Lamotrigine; D000078330:Oxcarbazepine