Depression lithium

Aromatic steroids are virtually insoluble in liquid ammonia and a cosolvent must be added to solubilize them or reduction will not occur. Ether, ethylene glycol dimethyl ether, dioxane and tetrahydrofuran have been used and, of these, tetrahydrofuran is the preferred solvent. Although dioxane is often a better solvent for steroids at room temperature, it freezes at 12° and its solvent effectiveness in ammonia is diminished. Tetrahydrofuran is infinitely miscible with liquid ammonia, but the addition of lithium to a 1 1 mixture causes the separation of two liquid phases, one blue and one colorless, together with the separation of a lithium-ammonia bronze phase. Thus tetrahydrofuran and lithium depress the solubilities of each other in ammonia. A tetrahydrofuran-ammonia mixture containing much over 50 % of tetrahydrofuran does not become blue when lithium is added. In general, a 1 1 ratio of ammonia to organic solvents represents a reasonable compromise between maximum solubility of steroid and dissolution of the metal with ionization. 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Other Drugs. Agents not considered to be CNS stimulants yet employed for the treatment of certain types of depression includes lithium carbonate for the treatment of bipolar disorder. In most patients, lithium is the sole agent used to control manic behavior and is very effective (see... 

The presence of inorganic salts may enhance or depress the aqueous solubiUty of boric acid it is increased by potassium chloride as well as by potassium or sodium sulfate but decreased by lithium and sodium chlorides. Basic anions and other nucleophiles, notably borates and fluoride, greatly increase boric acid solubihty by forrning polyions (44). 

Despite the statement above concerning the acid lability of cyclic formals, Gold and Sghibartz have shown that the acid catalyzed hydrolysis of these compounds is markedly depressed by some metal ions . Although the smaller cyclic formals did not exhibit a substantial rate reduction even in the presence of small cations like lithium, in certain larger systems the rate reduction was more than an order of magnitude. 

Synthesis of the CNS depressant/tranquil izer tioperidone (59) begins by alkylation of piperazine derivative with 4-chlorobutyronitrile to give Lithium aluminum hydride... 

Horton (H9, H10) has obtained additional acoustic-admittance data for a series of composite propellants. At a given frequency, decreasing the mean oxidizer particle size increases the acoustic admittance and thereby the tendency for instability. Horton also investigated the effects on the acoustic admittance of the incorporation of traces of copper chromite, a known catalyst, for the decomposition of ammonium perchlorate, lithium fluoride (a burning-rate depressant), and changes in binder these data are difficult to analyze because of experimental errors. 

Although lithium is not a true antipsychotic drug, it is considered with the antipsychotics because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a psychiatric disorder characterized by severe mood swings of extreme hyperactivity to depression). During the manic phase, the person experiences altered thought processes, which can lead to bizarre delusions. The drug diminishes the frequency and intensity of hyperactive (manic) episodes. 

There is an additive bone marrow depression when methimazole or propylthiouracil is administered with otiier bone marrow depressants, such as the antineo-plastic drugs, or witii radiation therapy. When methimazole is administered with digitalis, there is an increased effectiveness of the digitalis and increased risk of toxicity. There is an additive effect of propylthiouracil when the drug is administered with lithium, potassium iodide, or sodium iodide When iodine products are administered with litiiium products, synergistic hypotiiyroid activity is likely to occur. 

Lithium compounds are used in ceramics, lubricants, and medicine. Small daily doses of lithium carbonate are an effective treatment for bipolar (manic-depressive) disorder but scientists still do not fully understand why. Lithium soaps—the lithium salts of long-chain carboxylic acids—are used as thickeners in lubricating greases for high-temperature applications because they have higher melting points than more conventional sodium and potassium soaps. 

Medications that have been used as treatment for anxiety and depression in the postwithdrawal state include antidepressants, benzodia2epines and other anxiolytics, antipsychotics, and lithium. In general, the indications for use of these medications in alcoholic patients are similar to those for use in nonalcoholic patients with psychiatric illness. However, following careful differential diagnosis, the choice of medications should take into account the increased potential for adverse effects when the medications are prescribed to alcoholic patients. For example, adverse effects can result from pharmacodynamic interactions with medical disorders commonly present in alcoholic patients, as well as from pharmacokinetic interactions with medications prescribed to treat these disorders (Sullivan and O Connor 2004). 

Dorus and colleagues (1989) conducted a multicenter, double-blind, placebo-controlled trial in depressed and nondepressed alcoholic veterans. A total of 457 male alcoholic patients, of whom approximately one-third were depressed, were randomly assigned to receive either 600-1,200 mg/day of lithium or a comparable number of placebo capsules. No significant differ-... 

Dorus W, Ostrow DG, Anton R, et al Lithium treatment of depressed and nondepressed alcoholics. JAMA 262 1646—1632, 1989... 

Cornelius JR, Salloum IM, EhlerJG, et al Fluoxetine in depressed alcoholics a doubleblind, placebo-controlled trial. Arch Gen Psychiatry 54 700—705, 1997 Cornelius JR, Salloum IM, Haskett RF, et al Fluoxetine versus placebo for the marijuana use of depressed alcoholics. Addict Behav 24 111—114, 1999 Cui S-S, Bowen RC, Gu G-B, et al Prevention of cannabinoid withdrawal syndrome by lithium involvement of oxytocinergic neuronal activation. J Neurosci 21 9867— 9876, 2001... 

Depression and mania are both affective disorders but their symptoms and treatments are quite distinct. Mania is expressed as heightened mood, exaggerated sense of self-worth, irritability, aggression, delusions and hallucinations. In stark contrast, the most obvious disturbance in depression is melancholia that often co-exists with behavioural and somatic changes (Table 20.1). Some individuals experience dramatic mood swings between depression and mania. This is known as "bipolar disorder which, like mania itself, is treated with lithium salts or neuroleptics. 

It has been long believed that a lithium ion-selective electrode would render obsolete the flame photometer in the clinical laboratory. Lithium is administered to manic depressive psychiatric patients. Since the therapeutic range (0.5-1.5 mM) is quite close to the toxic range (>2 mM), it must be closely monitored. Most of the iono-phores propo d to date have not met the Li" /Na selectivity required for an interference-free assay. However, it has been reported that calibration in the presence of 140 mMNa permitted the analysis of Li in serum The errors observed are due to fluctuations in the Na concentrations in the sample. More selective ionophores would certainly improve the accuracy of this method. 

Electroconvulsive therapy (ECT) is the application of prescribed electrical impulses to the brain for the treatment of severe depression, mixed states, psychotic depression, and treatment-refractory mania in patients who are at high risk of suicide. It also may be used in pregnant women who cannot take carbamazepine, lithium, or divalproex. 

Optimize the dose of mood stabilizing medication(s) before adding on lithium, lamotrigine, or antidepressant (e.g., bupropion or an SSRI) if psychotic features are present, add on an antipsychotic ECT used for severe or treatment-resistant depressive episodes or for psychosis or catatonia... 

Electroconvulsive therapy (ECT) is used for severe mania or depression during pregnancy and for mixed episodes prior to treatment, anticonvulsants, lithium, and benzodiazepines should be tapered off to maximize therapy and minimize adverse effects. 

Lamotrigine is effective for the maintenance treatment of bipolar disorder. It is more effective for depression relapse prevention than for mania relapse. Its primary limitation as an acute treatment is the time required for titration to an effective dosage. In addition to maintenance monotherapy, it is sometimes used in combination with lithium or divalproex, although combination with divalproex increases the risk of rash, and lamotrigine dosage adjustment is required.37... 

Treatment of depressive episodes in bipolar disorder patients presents a particular challenge because of the risk of a pharmacologic mood switch to mania, although there is not complete agreement about such risk. Treatment guidelines suggest lithium or lamotrigine as first-line therapy.17,41 Olanzapine has also demonstrated efficacy in treatment of bipolar depression, and quetiapine is under review for approval of treatment of bipolar depression.42 When these fail, efficacy data support use of antidepressants. 

Mendlewicz, J., Verbanck, P., Linkowski, P. Wilmotte, J. (1978). Lithium accumulation in erythrocytes of manic-depressive patients an in vivo twin study. Br. J. Psychiatry, 133,436-44. 

Can be found in small amounts almost everywhere. Soft element, the lightest solid element. Common in chemistry as a hydride. Organolithi-um compounds are important synthetic building blocks. Lithium became popular as an anode metal for powerful batteries as the lithium ion is small and mobile. These energy dispensers can be very small and provide power for pacemakers, hearing aids, etc. Lithium salts are employed in lubricants and in fireworks (red color). Lithium ions act against depression. 

Turning to the pharmacotherapy for mania, for decades lithium was the only effective drug treatment. More recently, a number of antiepileptic drugs including carba maze pine, lamotrigine and valproate have been shown to also act as mood stabilisers and are becoming established for the treatment and prophylaxis of both unipolar mania and bipolar manic depressive disorders. 

---