Psychiatric treatment, lithium

Lithium for the treatment of manic episodes or bipolar disorder was originally promoted to the public and to the mental health profession as the ultimate example of a specific biochemical treatment for a specific psychiatric disorder. To bolster this claim, it was said that lithium lacks any brain-disabling effects on either patients or normal volunteers. This view of lithium directly challenges the concept of medication spellbinding and brain-disabling principle of psychiatric treatment. Although a number of new drugs have now been added to the mood stabilizer armamentarium, lithium remains the prototype. 

Cade s leap from producing a toxic lethargy in animals to treating human beings shows his intuitive recognition of the central role of deactivation in psychiatric treatment. As reviews by Schou (1957, 1968, 1976) indicated, no large studies on primate behavior were conducted before the widespread use of lithium in humans. One reason for this may be indicated in Schou s summary of how lithium affected mice and rats. 

Close therapeutic monitoring of plasma drug levels is required during lithium treatment lithium is the first psychiatric drug that required blood level monitoring... 

Modem psychiatric treatments were introduced in 1948, when lithium carbonate was discovered as a treatment for mania by Australian psychiatrist John F. Cade. After Cade s initial report, lithium treatment was principally developed in Denmark by Mogens Schou (1918-), beginning in 1954. After a decade of trials by these and other groups in the USA and abroad, the Psychiatric Association and the Lithium Task Force recommended lithium to the Food and Drug Administration for therapy of mania in 1969, 20 years after its discovery by Cade. In 1970, the FDA approved the prescription drug. A breakthrough had finally been achieved in the treatment and prevention of one of the world s major mental health problems in the form of manic depression, and the genetically related forms of recurrent depression. 

In noncancer-related pharmacology, GSK3 is inhibited by lithium at therapeutic concentrations, implying that the long-established effectiveness of lithium in the treatment of psychiatric mood disorders (and more recently as a neuroprotective agent) may be linked to GSK3 inhibition. Antipsychotics such as haloperidol... 

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). 

In a study of psychiatric patients after 1 week of lithium treatment, the serum Li+ level was typically 1 mM, whereas in brain and muscle the levels were 0.4 and 0.5 mM, respectively. Within the brain itself, the distribution of Li+ appears to be uneven however no particular region appears to accumulate Li+ to any significant extent [47]. It has been... 

It is common for both the depressive and manic phases to occur simultaneously in what is termed a mixed state or dysphoric mania. During these mixed episodes, the patient s mood is characterized by symptoms of both a depression and mania. Mixed episodes often have a poorer outcome than classic euphoric mania and, as a rule, respond better to certain anticonvulsants and atypical antipsychotic drugs than to lithium. As many as 50% of admissions to inpatient psychiatric facilities for the treatment of manic episodes appear to be for mixed manic states. The recognition... 

Goodwin FK, Goldstein MA. Optimizing lithium treatment in bipolar disorder a review of the literature and clinical recommendations. J Psychiatr Pract 2003 9(5) 333-343. 

Are childhood psychiatric histories of bipolar adolescents associated with family history, psychosis, and response to lithium treatment / Affect Disord 51 153-164. 

According to the Expert Consensus Panel for Mental Retardation Rush and Frances, (2000), the mainstays of the pharmacological treatment of acute mania or bipolar disorder in adults are anticonvulsant medications (divalproex, valproic acid, or carbamazepine) or lithium. Both divalproex or valproic acid and lithium were preferred treatments for classic, euphoric manic episodes. Divalproex or valproic acid was preferred over lithium and carbamazepine for mixed or dysphoric manic episodes and rapid-cycling mania. For depressive episodes associated with bipolar disorder, the addition of an antidepressant (SSRI, bupropion, or venlafaxine) was recommended. According to the Expert Consensus Panel, the presence of MR does not affect the choice of medication for these psychiatric disorders in adults. 

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... 

Goodwin FK, Roy-Byrne P Treatment of bipolar disorders, in Psychiatry Update The American Psychiatric Association Annual Review, Vol 6. Edited by fJales RE, Francis AJ. Washington, DC, American Psychiatric Press, 1987, p 89 Goodwin FK, Murphy DL, Bunney WE lithium-carbonate treatment in depression and mania a longitudinal double-blind study. Arch Gen Psychiatry 21 486-496, 1969... 

Levine J, Barak Y, Gonsalves M, et al A double-blind controlled trial of inositol treatment of depression. Am J Psychiatry 152 792-794, 1995a Levine J, Pomerantz T, Stier S, et al Lack of effect of 6 g inositol treatment on post-ECT cognitive function in humans. J Psychiatr Res 29 487-489, 1995b Levy A, Zohar J, Belmaker RH The effect of chronic lithium pretreatment on rat brain muscarinic receptor regulation. Neuropharmacology 21 1199-1201, 1983 Levy AB, Dixon KN, Schmidt H Sleep architecture in anorexia nervosa and bulimia. Biol Psychiatry 23 99-101, 1988... 

Meltzer HY, Simonovic M, Sturgeon RD, et al Effect of antidepressants, lithium and electroconvulsive treatment on rat serum prolactin levels. Acta Psychiatr Scand Suppl 290 100-121, 1981... 

Odagaki Y, Koyama T, Matsubara S, et al Effects of chronic lithium treatment on serotonin binding sites in rat brain. J Psychiatr Res 24 271-277, 1990 O Dwyer AM, Lightman SL, Marks MN, et al Treatment of major depression with metyrapone and hydrocortisone. J Affect Disord 33 123-128, 1995 Oehrberg S, Christiansen PE, Behnke K, et al Paroxetine in the treatment of panic disorder a randomised, double-blind, placebo-controlled study. Br J Psychiatry 167(3)374-379, 1995... 

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