Which of the following is used as a mood stabilizer ?

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  1. Sertraline
  2. Lithium
  3. Phenytoin
  4. Diazepam

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Saraswathi.B's picture

Answer: 

Lithium

Lithium

Lithium is an antimanic drugs or mood stabilizing drugs. And it is a monovalent cation.

Mechanism

It inhibits hydrolysis of inositol 1 phosphate by inositol monophophatase. As a result the supply of free inoitol for regeneration of membrane phosphatidyl inositides which are the source of IP3 and DAG is reduced. The hyperactive neurones involved in the manic state may be preferntailly affected because supply of inositol from the extracelular sources is meagre.

Uses

It is used a its carbonate salts because this is less hygroscopic and les gastric irritant than LICL or other salts. It is converted in to chloride in the stomach.

Sertraline

It is an anti depressent drug which comes under selective serotonin re uptake inhibitors. It has gained popularity. The drug interaction is due to it inhibition of CYP isoenzymes. Its plasma half life is 26 hours and it a longer lating active metabolite.

Phenytoin

5,5-diphenylimidazolidine-2,4-dione

Phenytoin is also called as diphenylhydration. It is an barbiturate analogue. It is an anti epileptic drug. It also consisting of anti convulsant activity.

Mechanism:

It is a stability influence on neuronal membrane which prevents repetitive detonation of normal brain cells during depolarization shift that occurs in the epileptic patients. This is achieved by prolonging the activated state of voltage sensitive neuronal Na channels that governs the refactory period of the neurons. As a result high frequency discharges are inhibited with little effect on the normal low frequency discharges which allows Na channels to recover even when in activation is prolonged. This effect can be noted at therapeutic concentrations of phenytoin. The intracellular accumulation of the Na that occurs during repetitive firing can be prevented.

Pharmacokinetics:

Absorption is by oral route is slow because of its poor solubility.

It is widely distributed on the body and is 80 to 90% bound to the plasma proteins. The therpeutic plasma concentration range is about 10 - 20 ug / ml.

It is metabolized in the liver by hydroxylation and glucuronide conjugation.

And only 5% unchanged phenytoin is excerted in urine.

Uses:

It is a first line anti epileptic drug for generalized tonic clonic simple and compound partial seizures. It is in effective in absence seizures. Used in status epilepticus and trigeminal nerralgia.

Diazepam

It is a smooth muscle relaxant. It is the prototype of benzodiazepines which acts in the brain on specific receptor enchancing GABAergic transmission. Muscle tone is reduced by supraspinal rather than spinal action, sedative activity ratio is low. No gastric irritation occurs and it is very well tolerated, though edation linits the dose which can be used for reducing muscle tone.

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