Lithium treatment guidelines

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. 

The safe and effective use of lithium is best ensured by close collaboration among patients, physicians, and significant others, all of whom must remain well-informed and up to date about treatment guidelines, benefits, adverse effects, risks, and precautions. While verbal communication and education is invaluable, it should be constructively supplemented with written information (45,46). 

Kleiner, J., Altshuler, L., Hendrick, V, and Hershman, J.M. (1999) Lithium-induced subclinical hypothyroidism review of the literature and guidelines for treatment. / Clin Psychiatry 60 249-255. 

Use alone or in combination with other drugs (e.g., lithium, valproate, antipsychotics) for the acute and long-term maintenance treatment of mania or mixed episodes for bipolar I disorder. APA guidelines recommend reserving it for patients unable to tolerate or who have inadequate response to lithium or valproate. 

Excess lithium aluminum hydride and the products of the treatment described above should be placed in an appropriate container, clearly labeled, and handled according to your institution s waste disposal guidelines. For more information on disposal procedures, see Chapter 7. ... 

---