Mood Stabilizer Informed Consent Form

This consent form outlines the agreement between the patient and Aspire Medical Group regarding the use of mood stabilizers as part of the patient’s treatment plan. It is important for the patient to understand the potential risks, benefits, and responsibilities associated with the use of mood stabilizers such as Lithium, Depakote (valproic acid), Lamictal (lamotrigine), Trileptal (oxcarbazepine), and Tegretol (carbamazepine) to ensure safe and effective treatment.

Mood stabilizers are medications used to treat mood disorders such as bipolar disorder, schizoaffective disorder, and treatment-resistant depression. They work by altering levels of neurotransmitters like glutamate and gamma-aminobutyric acid (GABA), which help regulate mood and behavior.

These medications help stabilize mood swings, reduce the intensity of manic or depressive episodes, and prevent future episodes. Common mood stabilizers include:

• Lithium: Primarily used to treat bipolar disorder by reducing manic episodes and preventing depressive episodes. Lithium also helps reduce the risk of suicide.
• Depakote (Valproic Acid): An anticonvulsant used as a mood stabilizer to treat manic episodes and prevent mood swings in bipolar disorder.
• Lamictal (Lamotrigine): An anticonvulsant used to prevent mood swings, particularly in patients who experience more depressive episodes than manic ones.
• Trileptal (Oxcarbazepine): An anticonvulsant used for mood stabilization in bipolar disorder, particularly for patients who cannot tolerate other medications.
• Tegretol (Carbamazepine): Another anticonvulsant used as a mood stabilizer, effective for patients with bipolar disorder or those experiencing frequent mood changes.

• Stabilization of mood and prevention of extreme mood swings
• Reduction in the frequency and severity of manic or depressive episodes
• Improved overall functioning and quality of life
• Prevention of future episodes in bipolar disorder
• Reduction in the risk of suicide (particularly with lithium)

Common Side Effects

• Lithium: Increased thirst and urination, weight gain, hand tremors, diarrhea or nausea, thyroid or kidney issues (with long-term use)
• Depakote (Valproic Acid): Drowsiness or dizziness, weight gain, nausea or stomach pain, hair loss, tremors, increased risk of liver damage or pancreatitis
• Lamictal (Lamotrigine): Drowsiness or dizziness, nausea or vomiting, headaches, blurred vision, serious risk: rare but potentially life-threatening rash (Stevens-Johnson syndrome)
• Trileptal (Oxcarbazepine): Drowsiness or dizziness, nausea or vomiting, headaches, loss of coordination, low sodium levels (hyponatremia)
• Tegretol (Carbamazepine): Drowsiness or dizziness, nausea or vomiting, blurred vision or double vision, increased risk of bone marrow suppression and low white blood cell count, serious risk: rare but potentially life-threatening rash (Stevens-Johnson syndrome).

Serious Risks and Considerations

• Lithium Toxicity: Lithium has a narrow therapeutic range, meaning the difference between an effective dose and a toxic dose is small. Toxicity can occur with dehydration, excessive sweating, or even small increases in dosage. Symptoms of lithium toxicity include confusion, seizures, slurred speech, and severe drowsiness. Regular blood tests are required to monitor lithium levels.
• Liver and Pancreas Damage (Depakote): Depakote can increase the risk of liver damage and pancreatitis, especially in young children or those with a history of liver disease. Regular blood tests may be required to monitor liver function during treatment.
• Life-Threatening Rash (Lamictal, Tegretol): Lamictal and Tegretol have been associated with Stevens-Johnson syndrome (SJS), a rare but serious condition that starts as a rash and can progress to life-threatening skin conditions. Patients should seek medical attention immediately if a rash develops.
• Low Sodium (Trileptal): Trileptal can cause hyponatremia (low sodium levels), which can be dangerous. Symptoms include headache, confusion, seizures, and fatigue. Regular blood tests may be needed to monitor sodium levels.
• Bone Marrow Suppression (Tegretol): Tegretol can cause low white blood cell counts, which may weaken the immune system. Regular blood tests may be required to monitor blood cell levels during treatment.
• Teratogenic Effects: Depakote and Tegretol are associated with a significant risk of birth defects if taken during pregnancy. Lamictal, Lithium, and Trileptal may also carry risks. Patients who are pregnant or planning to become pregnant should inform their prescriber immediately to discuss alternative treatment options.

Serum Monitoring: Regular blood tests may be required to monitor drug levels and ensure safety, particularly with lithium, Depakote, Trileptal, and Tegretol.

1. Non-Pharmacological Treatments

• Cognitive Behavioral Therapy (CBT) helps manage mood disorders by identifying and changing negative thought patterns and behaviors.
• Interpersonal and Social Rhythm Therapy (IPSRT) focuses on stabilizing daily rhythms, such as sleep, eating, and activities, to manage mood swings in bipolar disorder.
• Family-Focused Therapy involves family members in treatment to improve communication and reduce stress, helping prevent relapses.
• Mindfulness-Based Cognitive Therapy (MBCT): Combines cognitive therapy with mindfulness practices to help patients cope with depressive and anxious thoughts.
   

2. Non-Mood Stabilizer Medications

• Atypical antipsychotics like quetiapine (Seroquel) and olanzapine (Zyprexa) can help manage mood symptoms.
• Antidepressants (when used carefully in bipolar disorder with a mood stabilizer).
  Benzodiazepines for short-term management of severe anxiety or agitation (use with caution)
• Anxiolytics: Medications like buspirone or benzodiazepines may be prescribed for short-term relief of anxiety symptoms, although they carry risks such as dependence.
   

3. Lifestyle and Natural Approaches

• Exercise: Regular physical activity has been shown to naturally alleviate symptoms of depression by releasing endorphins and promoting better sleep and overall well-being.
• Diet: A balanced diet rich in fruits, vegetables, and omega-3 fatty acids can improve mental health. Deficiencies in certain nutrients, such as B vitamins and magnesium, have been linked to mood disorders.
• Mindfulness and Meditation: These practices can help reduce stress and improve emotional regulation, providing a non-invasive way to manage symptoms of depression and anxiety.
• Sleep Hygiene: Establishing a regular sleep routine and improving the quality of sleep can greatly improve mood and reduce anxiety.
• Herbal Supplements: Some patients may choose natural remedies such as St. John’s Wort or SAM-e. However, it’s important to consult with a healthcare provider before using these, as they may interact with other medications.

• Personal Use: I understand that my medication is intended for my personal use only. I will not share, sell, or misuse my medication.
• Dosage and Frequency: I will take my medication exactly as prescribed and will not alter the dosage or frequency without consulting my prescriber.
• Provider Notification: I will notify my prescriber of any new medications, supplements, or changes in symptoms or side effects.
• Regular Monitoring: I will attend all scheduled appointments for blood tests and physical exams to monitor my medication levels and overall health.
• Avoiding Substance Use: I will not combine my medication with alcohol or recreational drugs, as doing so may increase the risk of serious side effects.
• Pregnancy and Medication Use: I will inform my prescriber immediately if I become pregnant or intend to become pregnant during treatment to discuss potential risks.
• Safe Storage and Disposal: I will store my medication securely, out of reach of others, and return unused medication to a pharmacy for safe disposal.

• I have read and understand the information provided in this Mood Stabilizer Informed Consent Form.
• I have been given the opportunity to ask questions, and all my questions have been answered to my satisfaction.
• I understand and accept the risks, conditions, and terms of the proposed treatment.
• I agree to follow the prescribed treatment plan and attend all scheduled appointments.
• I consent to the use of Lithium, Depakote, Lamictal, Trileptal, and/or Tegretol as part of my treatment plan, and I understand that my treatment will be governed by the terms of this agreement.
• I acknowledge that my prescriber reserves the right to discontinue treatment or adjust the treatment plan if necessary.
• I understand that failure to comply with the terms of this agreement may result in the discontinuation of my mood stabilizer treatment or termination from the practice.
• I consent to the use of electronic records and signatures, and I acknowledge that I have read the related consumer disclosure.