“Be careful, doctor. Don’t order lab tests that you don’t really need. You’re asking for trouble.”

No, that’s not TCR talking. That’s none other than George Lundberg, M.D., former editor of JAMA. He made that statement in an editorial webcast in January 2005 on Medscape, where Dr. Lundberg is Editor-in-Chief (http://www.medscape. com/viewarticle/495665). He went on to point out, “The more lab tests that are done, the greater the chance for an abnormal result, whether or not the patient is sick.”

While this common sense statement may not be a news flash for many of us, it is something to bear in mind, particularly as we read guidelines and textbook chapters exhorting us to send our patients back to the lab over and over again for blood levels, CBCs, LFTs, and so on.

Therapeutic lab monitoring is a huge topic, deserving an entire issue unto itself – which I promise to deliver over the next few months. For now, I’ll simply list the typical textbook/guideline recommendations for lab monitoring of mood stabilizers, followed by an alternative set of recommendations reflecting the realities of practice in real-world settings, where patients don’t want to keep getting stuck unless there’s a really good reason for it.

Table: Lab Monitoring with Mood Stabilizers: Let’s Get Real