Manic-depressive behavior

One in every 1,000 people in the United States currently receives lithium, as Li2C03, for the treatment and prophylaxis of manic-depressive behavior. Doses of 250 mg to 2 g per day are administered in order to maintain a 0.5 to 2.0 mM concentration window, outside of which the drug is either toxic or ineffective. The detailed molecular mechanism by which Li ion brings about its remarkable chemotherapeutic effects is largely unknown, but there are various theories. One theory proposes that lithium binds to inositol phosphates, inhibiting their breakdown to inositol, and so reducing inositol-containing phospholipids. A consequence of this chain of events would be disruption of the neurotransmis-... 

Examples Lithium carbonate is an effective dmg for bipolar (manic-depressive) behavior. 

Bipolar disorder, previously known as manic-depressive illness, is a cyclical, lifelong disorder with recurrent extreme fluctuations in mood, energy, and behavior. Diagnosis requires the occurrence, during the course of the illness, of a manic, hypomanic, or mixed episode (not caused by any other medical condition, substance, or psychiatric disorder). 

Jones ED, Maas JW, Dekirmenjian H, et al Urinary catecholamine metabolites during behavioral changes in a patient with manic-depressive cycles. Science 179 300-302, 1973... 

Lewy AJ, Numberger JI, Wehr TA Supersensitivity to light possible trait marker for manic-depressive illness. Am J Psychiatry 142 725-727, 1985 Lewy AJ, Hughes RJ, Bauer VK, et al Melatonin modulation of brain and behavior clinical aspects, in Hormonal Modulation of Brain and Behavior. Edited by Halbreich U. Washington, DC, American Psychiatric Press (in press ... 

Mellow AM, Solano-Lopez C, Davis S Sodium valproate in the treatment of behavioral disturbance in dementia. J Geriatr Psychiatry Neurol 6 28-32, 1993 Meltzer HL Mode of action of hthium in affective disorders an influence on intracellular calcium functions. Pharmacol Toxicol 66 84-99, 1990 Meltzer HL, Kassir S, Dunner DL, et al Repression of a lithium pump as a consequence of hthium ingestion by manic-depressive subjects. Psychopharmacology 54 113-118, 1982... 

Baldessarini, R.J., Tondo, L., Hennen, J. Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. J. Clin. Psychiatry 60 (SuppL 2), 77-84, 111-116, 1999. 

Although the usefulness of the atypical antipsychotics is best documented for the positive symptoms of schizophrenia, numerous studies are documenting the utility of these agents for the treatment of positive symptoms associated with several other disorders (discussed in Chapter 10 see Fig. 10—2). Atypical antipsychotics have become first-line acute and maintenance treatments for positive symptoms of psychosis, not only in schizophrenia but also in the acute manic and mixed manic-depressed phases of bipolar disorder in depressive psychosis and schizoaffective disorder in psychosis associated with behavioral disturbances in cognitive disorders such as Alzheimer s disease, Parkinson s disease, and other organic psychoses and in psychotic disorders in children and adolescents (Fig. 11—52, first-line treatments). In fact, current treatment standards have evolved in many countries so that atypical antipsychotics have largely replaced conventional antipsychotics for the treatment of positive psychotic symptoms except in a few specific clinical situations. 

Precautions The tricyclic antidepressants should be used with caution in manic-depressive patients, since they may unmask manic behavior. The tricyclic antidepressants have a narrow therapeutic index for example, 5 to 6 times the maximal daily dose of imipramine can be lethal. Depressed patients who are suicidal should be given only limited quantities of these drugs and should be monitored closely. Drug interactions with the tricyclic antidepressants are shown in Figure 12.5. 

An apparent unfavorable result of lithium treatment was a reduction in enthusiastic behavior, as well as sexual responsiveness in the manic-depressive. Hypomanic joviality, enthusiasm, and spontaneity are often regarded as social pluses and manic-depressives and their spouses complain about the loss of these valued attributes. When pressed to discuss the sexual compatibility of the marriage, frequently they will say it is worse since lithium treatment started, as the lithium-treated spouse has less libidinal strivings. 

Dr. J. F. J. Cade, an Australian psychiatrist, first reported on the beneficial use of a lithium compound for a psychiatric disorder, namely, manic behavior in 1949. The early human trials were undertaken after initial experiments on rats, which became quite lethargic after treatment with lithium urate. Fairly large doses were required for treating manic behavior and its use for this disorder has been displaced by organic drugs that carry less risk. His report, however, led to its current nse as a treatment for bipolar affective disorder (also known as manic-depressive disorder). Its use in the United States was curtailed for a decade and a half by the US. Food and Dmg Administration (FDA), which based its decision on incidental poisonings due to overuse of a lithium-based table salt substitute, despite a safe record of controlled psychiatric apphcations in Europe. It has been estimated that by 1985... 

Bipolar (manic-depressive) disorder—periods of depression alternating with manic periods, which may include irritability, high or happy mood, excessive energy, behavior problems, staying up late at night, and grand plans. 

Lithium. The discovery that Li+ can control manic behavior in manic-depressive patients was reported before the appearance of CPZ. It is now widely used as Li2C03. No totally acceptable mechanism for its action exists. Postulations involve actions that would likely adjust overactive catecholaminergic activity, which is the accepted occurrence in mania. 

LF sometimes is used as an alternative or adjunct to antidepressants in severe, especially melancholic, recurrent depression, as a supplement to antidepressant treatment in acute major depression, including in patients who present clinically with only mild mood elevations or hypomania (bipolar II disorder), or as an adjunct when later response to an antidepressant alone is unsatisfactory. In major affective disorders, LT has stronger evidence of reduction of suicide risk than any other treatment. Clinical experience also suggests the utility of IF in the management of childhood disorders that are marked by adult-like manic depression or by severe changes in mood and behavior, which are probable precursors to bipolar disorder in adults. Evidence of efficacy of Li in many additional episodic disorders (e.g., premenstrual dysphoria, episodic alcohol abuse, and episodic violence) is unconvincing. 

The chemical elements are essential to each of us in our daily lives. The most important element is carbon, which is found in virtually all of the molecules that make up the living cell. Although certain elements are present in our bodies in tiny amounts, these elements can have profound effects on our health and behavior. As we will see in this chapter, lithium can be a miracle treatment for someone with manic-depressive disease, and our cobalt levels can have a remarkable impact on behavior. Many elements in our bodies serve no useful purpose, but they are found in the food we eat, the water we drink, and the air we breathe. As a result, the human body typically contains significant amounts of elements such as aluminum, barium, strontium, uranium, and gold, which are usually deposited in the bones or liver. 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

Chemistry is also apparently very important in determining a person s behavior. Various studies have shown that many personality disorders can be linked directly to imbalances of trace elements in the body. For example, studies on the inmates at Stateville Prison in Illinois have linked low cobalt levels with violent behavior. Lithium salts have been shown to be very effective in controlling the effects of manic depressive disease, and you ve... 

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