Attention deficit-hyperactivity disorder lithium

Strober, M., DeAntonio, M., Schmidt-Lackner, S., Freeman, R., Lam-pert, C., and Diamond,/. (1998) Early childhood attention deficit hyperactivity disorder predicts poorer response to acute lithium therapy in adolescent mania. / Affect Disord 51 145-151. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

Presumed lithium-related renal insufficiency occurred in a 13-year-old boy with bipolar disorder, Asperger s syndrome, and attention deficit hyperactivity disorder, who had taken lithium for over 5 years [51" ]. He had congenital absence of one kidney and previously had one episode of mild lithium toxicity. Kidney biopsy showed membranous glomerulonephropathy, which may have been related to lithium or to another kidney condition. 

Perhaps even more important in children is the issue of bipolar disorder. Mania and mixed mania have not only been greatly underdiagnosed in children in the past but also have been frequently misdiagnosed as attention deficit disorder and hyperactivity. Furthermore, bipolar disorder misdiagnosed as attention deficit disorder and treated with stimulants can produce the same chaos and rapid cycling state as antidepressants can in bipolar disorder. Thus, it is important to consider the diagnosis of bipolar disorder in children, especially those unresponsive or apparently worsened by stimulants and those who have a family member with bipolar disorder. These children may need their stimulants and antidepressants discontinued and treatment with mood stabilizers such as valproic acid or lithium initiated. 

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