What Is Lithium and How Does It Work?

Abstract

Lithium is a chemical element symbolized by Li carrying atomic number three in the periodic table. It is a soft, silver-white metal belonging to the alkali metal group of chemical elements and has-beyond medical indications-several industrial applications, e.g., in heat-resistant glass and ceramics, and lithium-ion batteries.Because lithium is highly reactive, it is usually stored in mineral oil (paraffi n). As a medication, it is always used as one of its salts, for example, lithium carbonate, lithium sulfate, or lithium citrate. It is the lithium part of the salt, the lithium atom, that is effective, and it does not matter which salt is used; no clinically relevant differences have been found among the different lithium salts in clinical studies.As described earlier in Chap. 3 on lithium's history, lithium is an unusual and unique medication for the treatment of mood disorders because it is a chemical trace element, a small atom with unique pharmacological and chemical properties (Birch 2006 ). It is not known whether lithium plays a physiological role in humans. Since it is a simple element, one might think that lithium acts by a simple mechanism. The opposite is probably true; yet after more than 60 years of widespread clinical use, we still do not know exactly why lithium works so well for many patients suffering from mood disorders (Malhi et al. 2013 ). Table 4.1 summarizes important clinical aspects of lithium therapy that may be most relevant when investigating which molecular actions of lithium could be responsible for its clinical effects.Nevertheless, during the past decade, new evidence has expanded our understanding of how lithium might exert its mood-stabilizing properties in individuals suffering from bipolar disorder. As a result of novel insights into the mechanisms by which lithium might work, research has demonstrated that lithium induces its cellular and molecular effects, at least partially, by activating neurotrophic and neuroprotective pathways and their associated signaling mechanisms (Quiroz et al. 2010 ).

Dental and medical management of the patient with bipolar disorder

“…14 Both these enzymes rely on Magnesium as a cofactor to function and lithium prevents the enzyme from binding with the cofactor. 14 Inhibiting these two enzymatic pathways is a common mechanism of action with Lithium, however, the precise clinical contribution is unknown. Due to the low therapeutic index of Lithium, patients should have a thorough medical history taken and be closely monitored to prevent adverse effects.…”

“…Currently, two enzymatic pathways have been identified as the target of lithium which include the Inositol monophosphatase and glycogen synthase kinase‐3β 14 . Both these enzymes rely on Magnesium as a cofactor to function and lithium prevents the enzyme from binding with the cofactor 14 . Inhibiting these two enzymatic pathways is a common mechanism of action with Lithium, however, the precise clinical contribution is unknown.…”

“…The mechanism of action of lithium is complex, however, it is thought to affect steps within the cellular signaling cascade. Currently, two enzymatic pathways have been identified as the target of lithium which include the Inositol monophosphatase and glycogen synthase kinase‐3β 14 . Both these enzymes rely on Magnesium as a cofactor to function and lithium prevents the enzyme from binding with the cofactor 14 .…”

Is lithium neuroprotective? An updated mechanistic illustrated review

“…Although its exact mechanism of action remains elusive [1–3], lithium inhibits several enzymes involved in recycling membrane phosphoinositides in neurons [4, 5]. The depletion of second messenger phosphatidylinositol bisphosphate (PIP2) prevents the formation of inositol triphosphate (IP3) and diacylglycerol (DAG); these messengers are important in amine neurotransmission [5–7]. Biochemically, lithium modulates several factors such as enzymes, hormones, vitamins, transcription, and growth factors [7, 8].…”

“…The depletion of second messenger phosphatidylinositol bisphosphate (PIP2) prevents the formation of inositol triphosphate (IP3) and diacylglycerol (DAG); these messengers are important in amine neurotransmission [5–7]. Biochemically, lithium modulates several factors such as enzymes, hormones, vitamins, transcription, and growth factors [7, 8]. The therapeutic effects of lithium are mediated by modulating gene expression [9–12].…”