Mood disturbances lithium

For more than 40 years, Li+ has been used to treat mania. While it is relatively inert in individuals without a mood disorder, lithium carbonate is effective in 60 to 80% of all acute manic episodes within 5 to 21 days of beginning treatment. Because of its delayed onset of action in the manic patient, Li+ is often used in conjunction with low doses of high-potency anxiolytics (e.g., lo-razepam) and antipsychotics (e.g. haloperidol) to stabilize the behavior of the patient. Over time, increased therapeutic responses to Li+ allow for a gradual reduction in the amount of anxiolytic or neuroleptic required, so that eventually Li+ is the sole agent used to maintain control of the mood disturbance. 

Two commonly used anticonvulsant medications for the treatment and prophylaxis of bipolar mood disorder in adults with MR are carbamazepine and valproic acid. Reid et al. (1981) compared carbamazepine to placebo in a double-blind, crossover fashion in 12 overactive adults with severe MR. Those described as having elevated moods and distractibility responded to treatment, while those without mood disturbance did not. Glue (1989) treated 10 adults with MR and rapidcycling bipolar mood disorder with lithium alone, lithium and carbamazepine, and carbamazepine alone. None of the patients treated with carbamazepine alone responded, while half of the patients showed partial or complete improvement with lithium alone or in combination with carbamazepine. 

Cartwright RD Rapid eye movement sleep characteristics during and after mood disturbing events. Arch Gen Psychiatry 40 197-201, 1983 Gasas M, Alvarez E, Duro P, et al Antiandrogenic treatment of obsessive-compulsive neurosis. Acta Psychiatr Scand 73 221-222, 1986 Gasebolt TL, Jope RS Long-term lithium treatment selectively reduces receptor-coupled inositol phospholipid hydrolysis in rat brain. Biol Psychiatry 25 329-340, 1989... 

In a controlled, cross-sectional comparison of 100 patients with mood disturbance who had taken lithium... 

In a double-blind, placebo-controlled study, 175 manic or recently manic patients were stabilized over 8-16 weeks with lamotrigine 100-400 mg/day (n = 59), lithium in a dose sufficient to produce a serum concentration of 0.8-1.1 mmol/1 (n = 46), or placebo and were then randomized to continued treatment (94). Both lamotrigine and lithium were superior to placebo in prolonging the time to the next episode of any mood disturbance. Lamotrigine, but not lithium, was superior to placebo in prolonging the time to a depressive episode. Lithium, but not lamotrigine, was superior to placebo in prolonging the time to a manic, hypomanic, or mixed episode. 

Lithium is also effective in individuals with co-morbid pathological gambling and a mood disturbance. In a randomized, 10-week, placebo-controlled study in 40 subjects randomly assigned to modified-release lithium or placebo, 83% of those who took lithium responded compared with only 29% of those who took placebo (100). 

In a controlled, cross-sectional comparison of 100 patients with mood disturbance who had taken lithium for at least 6 months and 100 psychiatrically normal controls, lithium did not increase the prevalence of thyroid autoimmunity a minimally larger number of control subjects had antithyroid peroxidase antibodies (11 controls versus 7 patients with mood disorders) and anti-thyroglo-bulin antibodies (15 versus 8) (259). 

For prophylaxis, lithium is indicated when there have been two episodes of mood disturbance in two years, although in some cases it is advisable to continue with prophylactic use after one severe episode. When an adequate dose of lithium is taken consistently, around 65% of patients achieve improved control of their illness. 

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. 

I particularly recalled my clinical work in 1958 and early 1959, when my assignment was to care for hospitalized soldiers and their dependents. We had few drugs to work with in those days. We relied mainly on Thorazine in the treatment of psychotic patients. It was the first major tranquilizer and preceded by decades the wonder drugs used today. For less severely disturbed patients we used meprobamate (Equanil) which has all but disappeared from today s pharmacies. In fact, the value of lithium, for mood swings, was just beginning to be accepted. 

Finally, Stroberetal. (183) conducted an 18-month, prospective, naturalistic follow-up study of 37 bipolar-l adolescents (i.e., 13 to 17 years old) stabilized on lithium and found a relapse rate almost three times higher in those who discontinued prophylactic lithium (92%), as compared with those who complied (38%). Further, they noted that earlier relapse in these patients predicted a greater risk of subsequent relapse and that an early onset may be associated with a more virulent course, resistance to lithium, and the need to consider alternative mood stabilizers. Methodological problems with this study included a small sample size lack of assessment for personality disturbances and intrafamilial environment only a 4-week initial drug stabilization period and lack of precision in monitoring compliance to treatment. 

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