How Should You Use the Lab to Monitor Patients Taking a Mood Stabilizer

The document discusses the importance of initial workup and ongoing monitoring for patients starting on mood stabilizers, such as lithium, valproate, carbamazepine, oxcarbazepine, and lamotrigine, for the treatment of bipolar I and II disorders. The International Society for Bipolar Disorders (ISBD) guidelines recommend a comprehensive initial workup that includes measurements of waist circumference or BMI, blood pressure, CBC, electrolytes, BUN and creatinine, liver function tests, fasting glucose, and fasting lipid profile, as well as documenting medical history and assessing for pregnancy in women of childbearing potential. Despite these guidelines, only one-third to one-half of patients on mood stabilizers are appropriately monitored, often due to poor adherence from patients and the segregation of psychiatric care from other medical care. For lithium specifically, patients should have thyroid function tests and, if over 40, ECG monitoring. Patients should also be educated on the potential side effects of lithium, signs of toxicity, and the importance of avoiding dehydration. Mood stabilizers can cause various side effects, including gastrointestinal, renal, neurologic, endocrine, cardiac, dermatologic, and hematologic issues.