Le lithium : monothérapie ou associations

Abstract

Efficacy of treatment with lithium is largely demonstrated in many indications. Its polyvalent effect is due to heterogenous pharmacological mechanisms on systems of neurotransmission and on complex cellular mechanisms. These effects explain both regulation of neurotransmission and neuroprotection. Clinicians are confronted with crucial question: Monotherapy or polytherapy where lithium is associated with one or several mood stabilizers. This decision is relevant for prevention of manic or depressive episodes, treatment of acute episodes, treatment of comorbidity and of resistant states in particular bipolar depression. In our reflexion, we underline that both polytherapy and polytherapy are recommended in clinical practice in more or less defined indications. Rigorous and rational decision should be based on complex neurochemical pharmacological effects of lithium in association with other psychotropic drugs: Synergical effects, neuroprotective effects and negative drug interactions.