Lithium therapy

Abstract

Since the introduction of lithium therapy 30 years ago it has become a major weapon in psychiatrists' armamentarium. It is the drug of first choice for the prevention of recurrent mood disorders, and it is estimated that about one person in every thousand people in Britain receives lithium at any one time. It therefore behoves doctors to be familiar with its use. This article is not a comprehensive account of the pharmacology of lithium (for this the reader is referred to Johnson (1987) and Peet & Pratt (1993)) but concentrates on its clinical use in practice and some less well known, but important, phenomena.

Old drug, new data

“…Since the publication of our original review (Ferrier et al, 1995) new information on adverse effects has become available. We give below a brief review of our current knowledge and discuss new findings on lithium toxicity and renal impairment.…”

“…The authors revisit a topic considered in the first volume of APT (Ferrier et al, 1995). That 1995 article is available on our website (http://apt.…”

Nefrotoxicidade por lítio

“…Its use has successfully caused a dramatic decrease in manic and depressive symptoms in 70 to 80% of patients 2 . However, despite such great success, lithium has a narrow therapeutic index, with therapeutic serum levels between 0.6 and 1.5 mEq/L 3,4 . In the initial phase of treatment, excessive thirst, nausea, diarrhea, epigastric pain, muscle weakness and fatigue are symptoms that cause great discomfort to patients, often leading to low adherence to medication 3 .…”

“…However, despite such great success, lithium has a narrow therapeutic index, with therapeutic serum levels between 0.6 and 1.5 mEq/L 3,4 . In the initial phase of treatment, excessive thirst, nausea, diarrhea, epigastric pain, muscle weakness and fatigue are symptoms that cause great discomfort to patients, often leading to low adherence to medication 3 . The most common neurologic symptom is tremor, affecting 25-50% of users.…”

Comparison of tremor induced by valproate and lithium in bipolar disorder using a hand steadiness tester

“…Tremor is the most frequent reason given by patients for discontinuing lithium. 4 On the other hand, sodium valproate is one of the few drugs available that has been proven effective in treating rapid cycling bipolar and mixed states patients. It is also approved for the treatment of mania.…”