---
title: "Laboratory Monitoring of Psychiatric Medications"
url: https://mghmclean.org/residents/handbk/part2c/lab.htm
description: "? = practice varies; *= EKG in children, patients >50 or with known cardiac disease or risk factors."
published: 2026-08-10
updated: 2026-08-10
---

# Laboratory Monitoring of Psychiatric Medications

Published 2026-08-10

PART 3 / CH 60

Roy Perlis (adapted from Jonathan Alpert)

A. Mood stabilizers

| drug | pre-rx | titration | during rx |
|---|---|---|---|
| Lithium | lytes/BUN/CrCBC, U/ATSHEKG*beta-HCG?24h urine | weekly level, Cr(draw level 12h post last dose; steady state takes 4-5d) | Level, Cr, TSH q6months or with new dose(q1-3months initially)EKG* q6-12mU/A q1year |
| valproate | CBC w/ diffLFTbeta-HCG | weekly level,CBC, LFT | Monthly level, LFT, CBC x6, then q6months |
| carbamazepine | CBC w/ diff,LFT,TSHbeta-HCGEKG* | weekly level, CBC, LFT | Monthly level, LFT, CBC x6, then q6months?TSH, lytes |

? = practice varies; *= EKG in children, patients >50 or with known cardiac disease or risk factors.

B. Antidepressants

· generally require no routine baseline or monitoring labs; check LFT’s if history of abnormality.

· exception: tricyclic antidepressants

- baseline EKG*

- levels may be useful in some settings

C. Antipsychotics

· all: signed consent form; AIMS test at baseline, every 6 months

· risperidone, low-potency agents: EKG*

· clozapine: weekly WBC with differential (see Clozapine section)