Psychiatric Pharmacy Essentials: Psychotropic Medication Monitoring: Antiepileptics / Mood Stabilizers

Antiepileptics and/or mood stabilizers are the cornerstones of bipolar disorder management. They each contain a unique set of monitoring parameters, including therapeutic drug monitoring. Patient-specific factors, such as mood state, organ function, and pregnancy status, may help guide clinicians on selecting the appropriate mood stabilizer.

  • Which tests and labs should be ordered for patients receiving mood stabilizers?1-5
  • How frequently should labs be ordered for patients receiving mood stabilizers?1,5
  • What are the risks of using mood stabilizers in pregnancy?6,7
  • How do we manage adverse effects associated with mood stabilizers?5,8

Reviewer 1: Allison Beatty, PharmD, BCPP
Reviewer 1: Austin Smith, PharmD, BCPP
2024-2025 AAPP Resident and New Practitioner Committee

Essential Questions and References

  1. Cullison SK, Resch WJ, Thomas CJ. How should you use the lab to monitor patients taking a mood stabilizer? Current Psychiatry. 2014;13(7):51-5. [Weblink] (Requires free account creation)
  2. Finley PR. Drug interactions with lithium: an update. Clin Pharmacokinet. 2016;55(8):925-41. [PubMed]
  3. Singh LK, Nizamie SH, Akhtar S, Praharaj SK. Improving tolerability of lithium with a once-daily dosing schedule. Am J Ther. 2011;18(4):288-91. DOI: 10.1097/MJT.0b013e3181d070c3. PubMed PMID: 20592663.
  4. Ketter TA. Strategies for monitoring outcomes in patients with bipolar disorder. Prim Care Companion J Clin Psychiatry. 2010;12(Suppl 1):10-6. DOI: 10.4088/PCC.9064su1c.02. PubMed PMID: 20628501; PubMed Central PMCID: PMC2902193.
  5. Yatham LN, Kennedy SH, Parikh SV et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 Guidelines for the Management of Patients with Bipolar Disorder. Bipolar Disord. 2018;20(2):97-170. [Weblink].
  6. Deligiannidis KM, Byatt N, Freeman MP. Pharmacotherapy for mood disorders in pregnancy: a review of pharmacokinetic changes and clinical recommendations for therapeutic drug monitoring. J Clin Psychopharmacol. 2014;34(2):244-255. [PubMed]
  7. ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008 Apr;111(4):1001-20. [PubMed]
  8. Kemp DE. Managing the side effects associated with commonly used treatments for bipolar depression. J Affect Disord. 2014;169 Suppl 1:S34-44. DOI: 10.1016/S0165-0327(14)70007-2. PubMed PMID: 25533913.