Challenging the Negative Perception of Lithium and Optimizing Its Long-Term Administration.

Janusz K Rybakowski

doi:10.3389/fnmol.2018.00349

Abstract

The use of lithium for the prevention of recurrences in mood disorders has a 55-year history. Nowadays, lithium is universally accepted as the first-choice mood-stabilizer (MS) for maintenance treatment of bipolar disorder. In addition to its mood-stabilizing properties, lithium exerts anti-suicidal, immunomodulatory and neuroprotective action which may further substantiate its clinical usefulness. Despite these facts, the use of lithium in mood disorders has been greatly underutilized. The reasons include the introduction and promoting other MS as well as a perception of lithium as a “toxic drug” due to its side effects, mainly thyroid, renal and cognitive disturbances. The trends in lithium prescription in recent decades show relative stability or a decline at the expense of other mood-stabilizing drugs, both first generation (valproate) and second generation (olanzapine, quetiapine, lamotrigine). In this review article, the negative perception of lithium by some clinicians will be challenged. First, the data showing lithium superiority over other MS will be presented. Second, the lithium-induced side effects which can make a challenge for a more frequent application of this drug will be delineated, and their proper management described. Finally, an issue of benefits of long-term administration of lithium will be discussed, including the phenomenon of the “excellent lithium responders” (ER) as well as a subject of starting lithium prophylaxis early in the course of the illness. This review article is based on the 47-year experience with lithium therapy by the author of the article.

Highlights

In this year, the 55th anniversary of the first publication on lithium prophylactic effect in mood disorders (Hartigan, 1963) is observed
In the patient, having glomerular filtration rate (GFR) of 32 ml/min/1.73 m2), in whom GFR decreased by 14%, and serum creatinine increased by 10%, we reduced the lithium dose and arranged systematic nephrological consultations
The evidence provided in this review article strongly suggest that negative perception of lithium as a first-line candidate for the prophylaxis of bipolar disorder can be challenged, based on the data showing its clinical efficacy and the possibility of managing its main adverse effects

Summary

INTRODUCTION

The 55th anniversary of the first publication on lithium prophylactic effect in mood disorders (Hartigan, 1963) is observed. Karanti et al (2016) who studied changes in mood stabilizer prescription for bipolar disorder in Sweden during 2007–2013 found that lithium use decreased during the study period from 51% to 41%, with concomitant increase of lamotrigine (from 25% to 33%) and quetiapine (from 9% to 25%). In the second study, Nivoli et al (2010) analyzed long-term controlled trials lasting at least half a year, including 1,561 patients, of whom 534 were receiving lithium They showed that recent data rate the lithium prophylaxis as more effective against manic than against depressive relapses while previous research had suggested the nearly equal effectiveness of lithium against both mania and depression. In their review article, Ketter et al (2016) suggest a comparable efficacy of lithium and quetiapine in the treatment of acute episodes of bipolar disorder and its prophylaxis, and a significantly better effectiveness of combination therapy than either agent alone. The average lithium level in our cognition research was 0.65 mmol/l and, when required, the dose of lithium was diminished, resulting in a concentration of about 0.5 mmol/l

EXCELLENT LITHIUM RESPONDERS

Findings

CONCLUSION