Psychopathology during long‐term lithium treatment of patients with major affective disorders

Abstract

Thirty-seven patients with major affective disorders according to DSM-III and on continuous lithium treatment were followed during a 7-year period. Outcome was assessed by use of the Comprehensive Psychopathological Rating Scale and by the need for additional psychotropic medication and for hospital and outpatient care. Anamnestic variables and patient's attitudes to their lithium medication were also included in the analysis of outcome, as were laboratory data, including lithium parameters. An increase in psychopathology was demonstrated in a significant number of patients and was attributed mainly to an increase in the depressive symptoms, with a significant increase in the rated scores for fatiguability, pessimistic thoughts, reduced sleep, and inner tension. Suicidal thoughts were common, but no suicide attempts were made. A significant number of patients complained of failing memory, but no significant progression was demonstrated during the 7-year study period. The increase in the depressive symptoms was closely correlated with the number of hospital admissions for depressive recurrence and with the number of days in hospital. The following factors showed a significant relationship with the increase in depressive symptoms: serum lithium levels, large increase in the elimination half-life of lithium, low level of social functioning, low TSH values, and need of concomitant administration of antidepressants and benzodiazepines.

Course of illness and pattern of recurrences in patients with affective disorders during long‐term lithium prophylaxis: a retrospective analysis over 15 years

“…Diagnosis, age and gender had no significant effect on the outcome. According to these data we cannot confirm any increase in depressive symptomatology during long-term lithium medication as has been reported by other authors (13).…”

What is the optimal serum lithium level in the long‐term treatment of bipolar disorder – a review?

“…The optimal lithium level for the prevention of depressive symptoms and/or episodes in the course of BD is still unclear. One naturalistic seven‐year follow‐up study of 37 patients with unipolar disorder and BD on continuous lithium treatment reported a positive relationship between increased depressive items on the Comprehensive Psychopathological Rating Scale (CPRS) and mean 12‐h lithium level (24). In addition, a meta‐analysis comparing the ratio of depressive to manic/hypomanic/mixed episodes at different serum lithium levels found higher lithium levels to be associated with an increased ratio of depressive to manic relapses/recurrences, while the opposite was true for lower levels (25).…”

The feasibility of neuropsychological endophenotypes in the search for genes associated with bipolar affective disorder

“…Lithium in particular has been associated with memory impairment (56) and reduced psychomotor speed (57). However, Nilsson and Axelsson (58) noted no progression of memory deficits in a sample of affective disorder patients treated continuously with lithium over a 7-year period. Much less is known regarding the cognitive effects of long-term usage of anticonvulsant and/or antidepressant medications, although preliminary evidence suggests a relatively benign cognitive profile (59).…”