The ‘collateral side’ of mood stabilizers: safety and evidence-based strategies for managing side effects

ABSTRACT

Introduction

Adverse events (AEs) monitoring of mood stabilizers (MS) is essential during the treatment of mood disorders as safety and tolerability profiles of MS may greatly influence treatment adherence, patient’s compliance, and discontinuation rate. Therefore, clinicians should be aware of their AEs profile and tapering a variety of strategies to manage them, according to an evidence-based approach.

Areas covered

We aimed at critically summarizing the tolerability and safety profile for each nonantipsychotic MS, providing evidence-based strategies able to manage these AEs, in order to increase clinically useful strategies which may allow clinicians enhancing adherence and therapeutic compliance, the impact on quality of life and treatment efficacy in psychiatric conditions.

Expert opinion

The management of the safety and tolerability profile of each MS comprises an initial assessment of the symptoms/signs to be observed/measured during the therapy, including a psychoeducational activity, a periodical monitoring with a specific timing depending on clinical parameters and each prescribed MS, but also an evaluation if a treatment modification (in terms of dose adjustment, discontinuation or additional medication to be prescribed) is required as well as which combination therapy is allowed and which caution should be posed by clinicians in some special conditions, including pregnancy and breastfeeding.

KEYWORDS:

• Mood stabilizers
• tolerability
• safety
• antiepileptics
• lithium

Article highlights

• Given their widely spread prescription and use, clinicians should be aware about the safety profile of nonantipsychotic mood stabilizers (MS)

• An early psychoeducational approach to clearly provide an exhaustive and informed description of the most commonly reported treatment-emergent adverse events (TEAEs)

• Clinicians should apply a periodical monitoring of specific clinical parameters depending on each specific nonantipsychotic MS

• Evidence-based strategies for the management and treatment of MS-related TEAEs, particularly those life-threatening, should be commonly shared.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.