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.
Course complete: all six sections are live — twenty-one chapters published. Chapters 1, 5 and 13 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 →
✅ Course complete
All six sections are live: twenty-one chapters, start to finish. Members can open every chapter now, along with every other course in the Academy.
Read free today
These chapters are free to read in full, not as summaries:
- Chapter 1: Lithium Toxicity: Recognition, Severity and When to Send to the ED
- Chapter 5: Lithium and Declining Kidney Function: CKD, Proteinuria and When to Reconsider Treatment
- Chapter 13: Starting and Restarting Lamotrigine: Titration, Valproate and Missed Doses
And four free clinical briefs written from the course:
What the course covers
Twenty-one chapters in six sections: lithium in two parts, then valproate, lamotrigine, carbamazepine and oxcarbazepine, and the problems shared by all of them. The full chapter list is below.
Lithium: Acute Toxicity & Level Problems
The emergency, the level that moved without explanation, and the neurological picture that is not simple toxicity.
3 chapters · 2 emergencyChapter 1 is free to readLithium: Long-Term Organ Effects
The kidney, thyroid and calcium effects that decide whether long-term lithium is still the right drug.
4 chaptersChapter 5 is free to readValproate
Liver, pancreas, ammonia and platelets: when a laboratory result means stopping, and when it does not.
4 chapters · 1 emergencyLamotrigine
The rash that must be triaged the same day, the titration that prevents it, and the rarer systemic reactions.
3 chapters · 1 emergencyChapter 13 is free to readCarbamazepine & Oxcarbazepine
HLA testing, serious rash, sodium, blood and liver toxicity, and the interactions that follow enzyme induction.
4 chapters · 1 emergencyAcross All Mood Stabilizers
Cardiac conduction, stopping safely, and the grid that puts every agent on one page.
3 chaptersQuestions this course answers
- A lithium level that rose without explanationChapter 2
- Suspected lithium toxicityChapter 1
- eGFR falling on long-term lithiumChapter 5
- New drowsiness on valproateChapter 9
- Low platelets on valproate before a procedureChapter 10
- A rash on lamotrigineChapter 12
- Missed lamotrigine dosesChapter 13
- HLA testing before carbamazepineChapter 15
- Sodium falling on oxcarbazepineChapter 16
- Stopping a mood stabilizerChapter 20
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.
What comes next in the series
This is the third course in Managing Psychopharmacology Adverse Events: A Rapid-Decision Series, after the complete Antipsychotics and Antidepressants courses. Two more are coming: Anxiolytics & Hypnotics, then Stimulants & ADHD.
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