Winter Sale on Lithium Levels: The Impact of Seasonality

Abstract

Amaç: Lityum duygudurum bozukluklarının koruma tedavisinde etkili bir ilaç olarak tüm dünyada tanınmaktadır. Lityumun bipolar bozukluk profilaksisindeki etkinliği yetmişli yılların başından beri kanıtlanmıştır. Lityum bipolar bozuklukta akut duygudurum epizodları farmakoterapisi, döngülerin önlenmesi, önleyici tedavi ve intiharın önlenmesinde dayanak noktası olmuş ve olmaya devam etmektedir. Bazı ülkelerde lityum düzeylerinin mevsimsel değişiklikleri olduğu şeklinde yayınlar mevcuttur. Winter sale on lithium levels: the impact of seasonality Objective: Lithium is recognized worldwide as an effective prophylactic agent in mood disorders. Prophylactic efficacy of lithium in mood disorders has been established since the early seventies. Lithium has been and continues to be the mainstay of bipolar disorder (BD) pharmacotherapy for acute mood episodes, switch prevention, and suicide prevention. There are reports of seasonal variation in lithium levels from a few countries. Variability in the lithium level can lead to a lack of efficacy or to toxicity, making seasonal variation clinically relevant. We aimed to compare lithium levels of bipolar patients between summer and winter. Methods: Euthymic bipolar patients who were followed in the Raşit Tahsin Mood Clinic of the Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were recruited for the study, and lithium levels were measured in the second part of winter and summer (15 th of June to 1st of September and 15 th of January to 1 st of March). A prospective case sheet audit was performed for 32 BD patients for recording plasma lithium level, age and gender for one year. Bipolar patients whose treatment dosage of lithium was changed for any reason during the study follow-up were excluded. Situations of lithium use other than for bipolar disorder were excluded. The presence of concomitant diagnoses of mental retardation or drug dependence constituted exclusion criteria, as did medication non-compliance detected by persistently low lithium plasma levels. The use of antihypertensive drugs, nonsteroidal anti-inflammatory drugs, theophylline, some antibiotics, topiramate, and diuretics that could cause an increase in plasma concentrations of lithium, and of theophylline that could reduce lithium concentrations constituted exclusion criteria. Sodium levels were also monitored due to their propable effect on lithium levels. Lithium levels were compared using the paired sample t-test. Correlation analysis was done for the parameters that could affect lithium levels. Results: The mean age of the patients was 35.75±9.59 years, the mean age of onset was 21.97±6.17 and the mean duration of disorder was 13.90±9.41 year. 15 out of 32 patients were male. The overall average dose of lithium taken by the patients was 1190.6±249.0 mg/day. The mean lithium plasma level was 0.75±0.12 mEq/L in winter, and the mean lithium plasma level was 0.83±0.12 mEq/L in summer (p=0.003). The overall serum sodium levels were 139.1±2.2 mEq/L in summer and 137.1±2.3 mEq/L i...

Seasonal and temperature effect on serum lithium concentrations

“…In contrast to previous European and Indian studies, we found no important differences over the years (Figures 2 and 5). These studies found higher serum lithium concentrations in summer months compared to winter/autumn with a variability between seasons of 25% in India (Medhi et al, 2008), 12% in Turkey (Bakim et al, 2013), 10% in Italy (Cusin et al, 2002) and 2–5% in the Netherlands (Beersma et al, 2002; Wilting et al, 2007). However, little clinical significance was demonstrated despite these reported differences.…”

“…Second, the average daily maximum temperature of the 5 days prior to the date of collection was recorded. Third, season and month of collection was recorded (as done in previous studies examining seasonal effects: Bakim et al, 2013; Beersma et al, 2002; Cusin et al, 2002; Medhi et al, 2008; Wilting et al, 2007). Seasonal transitions were marked by March 21 (Autumn), June 21 (Winter), September 21(Spring) and December 21(Summer).…”

“…The key predisposing factor to the development of chronic lithium toxicity is dehydration. A link between high temperatures, elevated serum lithium concentrations and increased incidence of drug toxicity has been demonstrated in some studies from the Northern Hemisphere (Bakim et al, 2013; Beersma et al, 2002; Cusin et al, 2002; Medhi et al, 2008; Wilting et al, 2007). High temperatures can change blood flow distribution and total body water, thereby altering lithium pharmacokinetics, including absorption, distribution and elimination (Hajat et al, 2010; Vanakoski and Seppälä, 1998).…”

Üniversite Öğrencilerinin Mevsimsellik ve Öznel İyi Oluş Düzeyleri Arasındaki İlişkide Depresyon ve Anksiyetenin Aracı Rolü

“…İnsanlar mevsim geçişlerine bağlı psikolojik semptomlar yaşamaktadır. Mevsime bağlı yaşantılara ve hava şartlarında görülen değişiklikler gibi çevresel faktörlerde meydana gelen değişime mevsimsel değişim, mevsimsellik adı verilmektedir (Bakım, Karaahmet, Altınbaş ve Oral, 2013). Bu değişimler rastgele değil, bir ritim içinde olmaktadır.…”

Mevsimsellik Ve Dindarlık İlişkisi

“…Mevsimlerin etkileri bağlamında tüm mevsimler için çatı bir kavram olarak kullanabileceğimiz ve mevsimlerin çevresel faktörlerde meydana getirdiği değişim (Bakım, Karaahmet, Altınbaş ve Oral, 2013) ve ruhsal durum, enerji, uyku süresi, iştah, yemek seçimi veya sosyal faaliyetleri etkileme derecesi olarak (Yöney vd., 1995) tanımlanan mevsimsellik; etkileri bakımından turizm (Aydemir & Şenerol, 2014), ticaret (Polat ve Uslu,2010), tarım (Bayraç ve Doğan,2016), ulaşım (Çalışkan vd., 2017) ağırlıklı bir kavram olarak değerlendirilmiş olsa da; insanlarda psikolojik semptomlara neden olduğu tespitinden (Kiremitçi Canıöz ve Coşkun,2018) hareketle psikolojik bir karşılığının bulunduğunu da söylemek mümkündür. Bu bağlamda mevsimsel değişimlerin kişileri psikolojik yönden etkilediği ön kabulünden hareketle, mevsimlere bağlı olarak görülen hava koşullarındaki değişimlerin duygu ve düşünce dünyasındaki olumlu / olumsuz yansımalarının anlamlandırılması bir problem olarak karşımızda durmaktadır.…”