Managing Mood Stabilizer Adverse Events
Twenty-one point-of-care chapters on what to do when lithium, valproate, lamotrigine, carbamazepine or oxcarbazepine causes the problem — recognition, differential, and a decision for each adverse effect, built for the clinician who has eight minutes and a patient waiting.
2 of 6 sections live — 7 chapters published. Section 3 releases 17 Oct. Chapters 1 and 5 are free to read.
What this course is for
Mood stabilizers are the drugs where an adverse effect is most often a decision rather than a nuisance. Lithium has a narrow margin between the level you want and the level that injures, and a new blood pressure tablet or a bout of diarrhoea can close it. Lamotrigine, carbamazepine and oxcarbazepine can cause rashes that mean stopping the drug the same day unless the rash is clearly not drug-related. Valproate can injure the liver and pancreas and raise ammonia enough to cloud consciousness.
Every chapter is built around the decision that follows. Is it the drug, the illness or something else, and what do I do now: continue, check a level, stop, or send the patient to the emergency department? Getting that call wrong in either direction is how a manageable adverse effect becomes an admission, or how an effective drug gets stopped for good.
Bedside panel first
Each chapter opens with a two-minute panel: do now, do not, the questions to ask, a red / amber / green triage and what to hand over. The detailed chapter follows below.
Numbers with denominators
Every figure names its study population. Where evidence is weak or contested, the chapter says so, and a threshold that could not be verified is not printed.
Built to use, not to read
Counselling scripts written for the phone call and copy-paste EMR notes in every chapter, so the work of the visit is already drafted.
The lithium toxicity triage, exactly as it appears in the chapter
- New neurological sign beyond the usual fine tremor
- Intentional ingestion, or any sustained-release overdose
- Cannot keep fluids down, or ongoing diarrhoea
- Known or suspected kidney injury
- Syncope, palpitations or a slow pulse
- Rigidity with fever, or clonus with agitation, in a patient on an antipsychotic or serotonergic drug
- Level above target with gastrointestinal symptoms only
- Fever or infection with reduced, but maintained, fluid intake
- Recent interacting drug start plus any illness
- You cannot examine the patient or trust the history
- Older patient who lives alone, with no one to observe
Well patient, level mildly above target, cause identified: hold lithium, stop the precipitant, repeat trough level and creatinine promptly, give clear return advice.
Every chapter opens with a bedside panel like this one — what to do now, what not to do, the questions to ask and the triage — before the detailed chapter begins. Chapter 1 is free to read →
📅 Releasing section by section
The six sections release in order, every few days, starting with lithium. Dates appear here as each one is confirmed.
Members get each section the day it publishes, at no additional cost, along with every other course in the Academy.
The 21 chapters
The emergency, the level that moved without explanation, and the neurological picture that is not simple toxicity.
The kidney, thyroid and calcium effects that decide whether long-term lithium is still the right drug.
- 4Lithium Polyuria and Nephrogenic Diabetes Insipidus
- 5Lithium and Declining Kidney Function: CKD, Proteinuria and When to Reconsider Treatment
- 6Lithium Thyroid, Calcium and Parathyroid Abnormalities
- 7Lithium Tremor, Cognitive Effects, Weight Gain and Skin Problems
Liver, pancreas, ammonia and platelets: when a laboratory result means stopping, and when it does not.
- 8Valproate Liver Injury, Pancreatitis and Serious Hypersensitivity: When to Stop
- 9Valproate Hyperammonemia: When to Check Ammonia and When to Stop
- 10Valproate Thrombocytopenia and Bleeding: CBC, Procedures and Dose Decisions
- 11Valproate Weight Gain, Metabolic Effects and Hair Loss
The rash that must be triaged the same day, the titration that prevents it, and the rarer systemic reactions.
- 12Lamotrigine Rash: When to Stop and How to Recognize SJS/TEN and DRESS
- 13Starting and Restarting Lamotrigine: Titration, Valproate and Missed Doses
- 14Systemic Illness on Lamotrigine: HLH, Aseptic Meningitis and Blood Dyscrasias
HLA testing, serious rash, sodium, blood and liver toxicity, and the interactions that follow enzyme induction.
- 15Carbamazepine/Oxcarbazepine Rash: SJS/TEN, DRESS, HLA Testing and Cross-Reactivity
- 16Carbamazepine/Oxcarbazepine Hyponatremia: When to Monitor, Reduce or Stop
- 17Carbamazepine Blood and Liver Toxicity: When to Stop
- 18Carbamazepine/Oxcarbazepine Drug Interactions: Induction, Autoinduction and Toxicity
Cardiac conduction, stopping safely, and the grid that puts every agent on one page.
- 19Mood Stabilizers and Cardiac Conduction: Lithium, Lamotrigine and Other Sodium-Channel Blockers
- 20Stopping Mood Stabilizers: Tapering and Reducing Recurrence Risk
- 21Quick-Reference Monitoring and Management Grid
Covered elsewhere in the Academy
Pregnancy and breastfeeding are covered in the Perinatal Psychopharmacology Series and the mood stabilizer breastfeeding lessons. General QTc management, heart failure and post-MI prescribing are in Psychopharmacology with Cardiac Impairment; this course covers the conduction effects specific to mood stabilizers.
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