Lithium compounds, also known as lithium salts, are primarily used as a psychiatric medication. This includes the treatment of major depressive disorder that does not improve following the use of other antidepressants, and bipolar disorder. In these disorders, it reduces the risk of suicide.
What is lithium salts used for?
Lithium salts are classified as mood stabilizers. How lithium works is not specifically known. In the nineteenth century, lithium was used in people who had gout, epilepsy, and cancer. Its use in the treatment of mental disorders began in 1948 by John Cade in Australia. It is on the World Health Organization's List of Essential Medicines.
Is lithium used in psychiatry in the US?
This article has been cited byother articles in PMC. Abstract Although used around the world since 1949, lithium has come into extensive use in psychiatry in the United States only within the past decade.
What is the role of lithium salts in the treatment of bipolar?
Lithium salts are considered to be antimanic agents and are used for the prophylaxis and treatment of bipolar disorder (manic-depressive psychosis) and as an adjunct to antidepressant therapy in melancholic depression (Baldessarini, 2006 ).
Is lithium used to treat Alzheimer's disease?
Tentative evidence in Alzheimer's disease showed that lithium may slow progression. It has been studied for its potential use in the treatment of amyotrophic lateral sclerosis (ALS), but a study showed lithium had no effect on ALS outcomes. ^ a b "Lithium brands".
Which disorder is lithium used to treat?
About lithium It's used to treat mood disorders such as: mania (feeling highly excited, overactive or distracted) hypo-mania (similar to mania, but less severe) regular periods of depression, where treatment with other medicines has not worked.
What are lithium salts used for?
Lithium salts are considered to be antimanic agents and are used for the prophylaxis and treatment of bipolar disorder (manic-depressive psychosis) and as an adjunct to antidepressant therapy in melancholic depression (Baldessarini, 2006).
What disorder is lithium carbonate used for?
This medication is used to treat manic-depressive disorder (bipolar disorder). It works to stabilize the mood and reduce extremes in behavior by restoring the balance of certain natural substances (neurotransmitters) in the brain.
Is lithium salt used to treat bipolar disorder?
Lithium treatment remains the “gold standard” of treatment for preventing recurrences in bipolar disorder, both types I (with mania and major depression) and II (with depression and hypomania). It also has evidence of effectiveness for preventing suicidal behavior in patients with bipolar or major depressive disorder.
Does lithium treat psychosis?
Clinically, lithium has also been used for treating severe psychosis symptoms, and lithium alone or lithium augmentation of antipsychotic medications is proposed as an effective treatment for some patients with schizophrenia24,31.
How do lithium salts work?
At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; however, these broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes.
How does lithium treat bipolar disorder?
Lithium helps reduce the severity and frequency of mania — the elevated, euphoric end of the mood scale — and may help to treat bipolar depression. If you have been at risk of suicide, lithium may help reduce these feelings. Lithium also helps prevent manic and depressive episodes occurring in the future.
Does lithium help with depression?
Lithium (Eskalith, Lithobid) is one of the most widely used and studied medications for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve or prevent bipolar depression. Studies show that lithium can significantly reduce suicide risk.
How safe is lithium for bipolar disorder?
A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher. Severe lithium toxicity happens at a level of 2.0 mEq/L and above, which can be life-threatening in rare cases.
When was lithium used for mental illness?
The use of lithium in psychiatry goes back to the mid-19th century. Early work, however, was soon forgotten, and John Cade is credited with reintroducing lithium to psychiatry for mania in 1949.
When was lithium first used to treat bipolar disorder?
While its use in psychiatry dates to the mid-19th century, the widespread discovery of lithium is usually credited to Australian psychiatrist John Cade who introduced it for mania in 1949.
Does lithium help with anxiety?
Lithium improves the body's ability to synthesize serotonin. This simply means that the body's levels of serotonin increase in response to lithium, which has the effect of improving mood and reducing feelings of anxiousness.
What is lithium salt used for?
Lithium salts are most frequently used in the continuation and prophylactic phases of the treatment of bipolar affective disorders, and it is in this role that the guidelines for their use are most clearly established. They may also have a place in the treatment of unipolar depressive illness. Although the relationship between dose and plasma levels is roughly linear, there is a wide variation between individuals, depending mainly upon differences in renal clearance. For this reason, as well as the low therapeutic index (i.e. the ratio between toxic and therapeutic dosage), it is important to assess renal function prior to starting treatment, and thereafter to monitor closely the serum lithium level until steady-state conditions are reached. Serum trough levels, measured 10–12 h after a dose, of between 0.5 and 0.8 mmol/litre are required to ensure efficacy, although in the face of persistent adverse effects it is possible to achieve therapeutic effect in most patients with serum levels of between 0.4 and 0.5 mmol/litre ( Baastrup et al., 1970; Coppen et al., 1971 ).
What drugs affect lithium levels?
They include diuretics (thiazides more than loop type), angiotensin -converting enzyme (ACE) inhibitors and angiotensin-II antagonists, and non-steroidal anti-inflammatory analgesics. Theophylline and sodium-containing antacids reduce plasma lithium concentration. These effects can be important because lithium has a low therapeutic ratio. Diltiazem, verapamil, carbamazepine and phenytoin may cause neurotoxicity without affecting the plasma lithium level.
What salts make you taste salty?
Sodium (and lithium) salts evoke salty taste. Certain potassium salts also stimulate salty taste, albeit poorly, and have been used as salt substitutes to reduce dietary Na + intake. Saltiness measures the mineral content of foods and controls the consumption of Na +, the predominant ion that maintains the body's fluid volume and blood pressure. The prototypic salty taste is table salt (NaCl), which has a human detection threshold of about 1∼30 mmol −1. Many commercially available soups contain NaCl at 100∼200 mmol −1, a concentration that tastes mildly to distinctly salty to many individuals. How taste bud cells in humans detect Na + salts arguably is not known. Mechanisms thought to explain salt taste in rodents are presented below.
How long does lithium carbonate take to work?
Lithium carbonate is effective treatment in more than 75% of episodes of acute mania or hypomania. Because its therapeutic action takes 2–3 weeks to develop, lithium is generally used in combination with a benzodiazepine such as lorazepam or diazepam (or with an antipsychotic agent where there are also psychotic features).
What is the best anticoagulant for chemistry?
Lithium or sodium salt of heparin at a concentration of 10–20 iu/ml of blood is a commonly used anticoagulant for chemistry, gas analysis and emergency tests. It does not alter the size of the red cells and it is recommended when it is important to reduce to a minimum the chance of lysis occurring after blood has been withdrawn. When red cells are required for testing, as in the investigation of certain types of haemolytic anaemia, the sample can be defibrinated (see previous editions for details) although heparinised blood is now more often used for such tests.
When was lithium carbonate first used?
Lithium salts were known anecdotally to have beneficial psychotropic effects as long ago as the middle of the 19th century, but scientific evidence of their efficacy was not obtained until 1949, when lithium carbonate was tried in manic patients; it was found to be effective in the acute state and, later, to prevent recurrent attacks.3
Is lithium a cation?
The therapeutic and toxic plasma concentrations are close (low therapeutic index). Lithium is a small cation and, given orally, is rapidly absorbed throughout the gut. High peak plasma concentrations are avoided by using sustained-release formulations which deliver the peak plasma lithium concentrations in about 5 h. At first lithium is distributed throughout the extracellular water, but with continued administration it enters the cells and is eventually distributed throughout the total body water with a somewhat higher concentration in brain, bones and thyroid gland. Lithium is easily dialysable from the blood but the concentration gradient from cell to blood is relatively small and the intracellular concentration (which determines toxicity) falls slowly. Being a metallic ion it is not metabolised, nor is it bound to plasma proteins.
How long has lithium been used?
Lithium has been used clinically for 70 years, mainly to treat bipolar disorder. Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries, encouraging this update about its safe clinical use.
When was lithium first used?
Lithium treatment finally received regulatory approval by the US Food and Drug Administration (FDA) in 1970 for treatment of acute mania, and in 1974 as the first—and for many years, the only—approved treatment for prevention of recurrences in bipolar disorder.
What was the first treatment for mania?
In 1949, John Cade (1929–1996), an Australian psychiatrist, serendipitously initiated a new era in psychiatric treatment by using lithium carbonate to treat mania. His use of lithium arose from the hypothesis that major mental illnesses might be associated with deficiencies or excesses of unidentified chemical substances, including accumulations of nitrogenous metabolites. This idea led him to give lithium carbonate to laboratory animals to limit toxicity of test substances including uric acid and noting calming and other behavioral changes. Subsequently, he reported on beneficial effects of treating ten patients with lithium carbonate (a medically accepted, though unproved, treatment for gout) for mania and on risks of discontinuing such treatment (Cade 1949 ). These encouraging initial results are now widely considered a revolutionary discovery, although this innovative and effective treatment was not immediately adopted by psychiatry. As Cade himself observed, “a discovery by an unknown psychiatrist without research training, working in a small hospital for the chronically mentally ill, with primitive techniques and negligible equipment, could not attract much attention” (Cade 1999 ). In addition, several cases of severe, acute intoxication associated with use of lithium salts as a substitute for table salt (sodium chloride) were reported in 1949, and some experience was required to learn how to use lithium safely. This could be achieved by measuring its concentration in blood (Amdisen 1967; Baldessarini 2013; Bauer and Gitlin 2016 ).
How long does it take for lithium to stabilize?
If a dose is changed, 5–7 days should pass before measuring the blood level to allow tissue distribution to stabilize. Optimal doses of lithium are decided by a clinician, and depend on the patient’s age, general health, type of bipolar disorder, symptom-severity, and frequency of recurrences.
Can lithium be used for psoriasis?
Lithium can be used cautiously and with close medical monitoring in the presence of: cardiac arrhythmia, reduced kidney function, psoriasis, myeloid leukemia, Addison’s disease, hypothyroidism, and certain neurological disorders, including abnormalities of posture and movement, myasthenia gravis, and epilepsy.
Does lithium cause tremors?
Some adverse effects are common during treatment with lithium. These include tremor (a dose-dependent effect, which can be treated with low doses of the centrally active, beta-adrenergic blocker propranolol, high doses of vitamin B6, or with dose reduction if possible), nausea, fatigue, increased appetite, increased white blood-cell count, thirst, and increased frequency of urination (polyuria). This symptom may respond to cautiously added, small doses of the diuretic hydrochlorothiazide (which can also increase serum concentrations of lithium and decrease potassium). Some patients complain of decreased cognitive functions. Some of these adverse effects (especially thirst and tremor) tend to disappear over the first weeks of treatment. Gastro-intestinal complaints may be lessened by switching to another lithium preparation. Hypothyroidism is also possible and usually is treated with supplemental thyroid-hormone (Ambrosiani et al. 2018; Bocchetta et al. 2018 ). Hyperparathyroidism and consequent hypercalcemia can also arise during long-term treatment with lithium (Twigt et al. 2013 ).
Can lithium salts be used for mood disorders?
We summarized recommendations concerning safe clinical use of lithium salts to treat major mood disorders, including indications, dosing, clinical monitoring, adverse effects and use in specific circumstances including during pregnancy and for the elderly.
What is lithium salt?
In addition, lithium salt is implicated in the possible stabilisation of thyroid microtubules, with the consequent influence of thyroid hormone release. The salt is also implicated in the transformation of T4–T3 in the neurons and in the periphery.
What medications are considered a risk to a child?
Some medications that may pose a risk to the child are lithium salts, valproic acid (Depakote, Depakene), cabamazepine (Tegretol), phenytoin (Dilantin), paroxetine (Paxil), clozapine (Clozaril) and various other nonpsychiatric medications. These and some other agents are listed in Table 25-5 If a psychiatric patient misses her period, or has other features of pregnancy, a serum or urine pregnancy test must be ordered. If the patient is pregnant and relativelystable, an intermittent or continuous drug holiday for the first three months must be considered. This will greatly reduce the chance of serious malformations. If the clinical condition does not allow this, a switch to less risky medications must be considered. Antenatal care must be arranged and closer psychiatric follow-up around the time of childbirth is strongly recommended.
Does lithium salt affect thyroid?
Lithium salt is concentrated in the thyroid at levels 3 or 4 times greater than in plasma and its antithyroid effects are well documented (Table 1 ), although the mechanisms responsible for these effects are complex. Lithium salt inhibits both the cellular processes mediated by cyclic adenosine monophosphate (AMP) and the action of the enzyme inositol monophosphatase, thus blocking the inositol phosphate pathway. Although these 2 effects explain the intracellular alterations, the mechanism as a whole is not completely understood.
Can lithium be used as an antidepressant?
As noted earlier, lithium salts have important antidepressant effects and can be used to augment an inadequate antidepressant response to divalproex, carbamazepine, or lamotrigine. The study by Young et al (2000) reviewed earlier found that the combination of divalproex and lithium was as effective as a mood stabilizer plus paroxetine combination, although less well tolerated. The next most important adjunctive therapeutic option for treatment of bipolar depression is thyroid hormone (Sachs 1996). Thyroid hormones can be prescribed to correct hypothyroidism, to treat more subtle states of relative thyroid hypofunction, or as adjuncts for a euthyroid antidepressant nonresponder. Clinicians often pick l -thyroxine (T 4) for the former indication and l -triiodothyronine (T 3; 25–50 mcg/day), for the latter purpose; however, the theoretic rationale for such a distinction is controversial (Joffe and Singer 1990). In studies of nonbipolar depression, adjunctive thyroid treatment typically results in 30%–50% response rates and is generally well tolerated (Aronson et al 1996). Higher doses of thyroid hormone are sometimes useful in cases of rapid cycling (Bauer and Whybrow 1990). Long-term, high-dose thyroid therapy may be associated with an increased risk of osteoporosis and, therefore, should be used with caution.
How does lithium work?
How lithium works is not specifically known. In the nineteenth century, lithium was used in people who had gout, epilepsy, and cancer. Its use in the treatment of mental disorders began in 1948 by John Cade in Australia. It is on the World Health Organization's List of Essential Medicines.
Why is lithium used in urine?
The dehydration is due to lithium inhibition of the action of antidiuretic hormone, which normally enables the kidney to reabsorb water from urine. This causes an inability to concentrate urine, leading to consequent loss of body water and thirst.
How does lithium affect AMP?
Lithium's therapeutic effects are thought to be partially attributable to its interactions with several signal transduction mechanisms. The cyclic AMP secondary messenger system is shown to be modulated by lithium. Lithium was found to increase the basal levels of cyclic AMP but impair receptor coupled stimulation of cyclic AMP production. It is hypothesized that the dual effects of lithium are due to the inhibition of G-proteins that mediate cyclic AMP production. Over a long period of lithium treatment, cyclic AMP and adenylate cyclase levels are further changed by gene transcription factors.
What is it called when you have too much lithium in your blood?
Lithium toxicity, which is also called lithium overdose and lithium poisoning , is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactions in the body.
What is lithium soda?
As with cocaine in Coca-Cola, lithium was widely marketed as one of a number of patent medicine products popular in the late-19th and early-20th centuries, and was the medicinal ingredient of a refreshment beverage. Charles Leiper Grigg, who launched his St. Louis-based company The Howdy Corporation, invented a formula for a lemon-lime soft drink in 1920. The product, originally named "Bib-Label Lithiated Lemon-Lime Soda", was launched two weeks before the Wall Street Crash of 1929. It contained the mood stabilizer lithium citrate, and was one of a number of patent medicine products popular in the late-19th and early-20th centuries. Its name was soon changed to 7 Up. All American beverage makers were forced to remove lithium in 1948. Despite the 1948 ban, in 1950 the Painesville Telegraph still carried an advertisement for a lithiated lemon beverage.
What is the effect of Li+ on the nervous system?
Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis. Unlike many other psychoactive drugs, Li+.
How do diuretics affect sodium and water levels?
Its levels are therefore sensitive to water and electrolyte balance. Diuretics act by lowering water and sodium levels; this causes more reabsorption of lithium in the proximal tubules so that the removal of lithium from the body is less, leading to increased blood levels of lithium.
Overview
Certain lithium compounds, also known as lithium salts, are used as psychiatric medication, primarily for bipolar disorder and for major depressive disorder that does not improve following the use of antidepressants. In these disorders, it sometimes reduces the risk of suicide. Lithium is taken orally.
Common side effects include increased urination, shakiness of the hands, and …
Medical uses
Lithium is approved by the United States Food and Drug Administration (FDA) for treatment of bipolar disorder, which is its primary use. It is sometimes used when other treatments are not effective in a number of other conditions, including major depression, schizophrenia, disorders of impulse control, and some psychiatric disorders in children. Because the FDA has not approved lithi…
Adverse effects
Sources for the following lists.
Very Common (> 10% incidence) adverse effects of lithium include
• Confusion
• Constipation (usually transient, but can persist in some)
• Decreased memory
Interactions
Lithium plasma concentrations are known to be increased with concurrent use of diuretics—especially loop diuretics (such as furosemide) and thiazides—and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Lithium concentrations can also be increased with concurrent use of ACE inhibitors such as captopril, enalapril, and lisinopril.
Lithium is primarily cleared from the body through glomerular filtration, but some is then reabsorb…
Overdose
Lithium toxicity, which is also called lithium overdose and lithium poisoning, is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactions in the body.
In acute toxicity, people have primarily gastrointestinal symptoms such as vomiting and diarrhea, which may result in volume depletion. During acute toxicity, lithium distributes later into the centr…
Mechanism of action
The specific biochemical mechanism of lithium action in stabilizing mood is unknown.
Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.
Unlike many other psychoactive drugs, Li typically produces no obvious psychotropic effects (su…
History
Lithium was first used in the 19th century as a treatment for gout after scientists discovered that, at least in the laboratory, lithium could dissolve uric acid crystals isolated from the kidneys. The levels of lithium needed to dissolve urate in the body, however, were toxic. Because of prevalent theories linking excess uric acid to a range of disorders, including depressive and manic disorders, Carl Lange in Denmark and William Alexander Hammond in New York City used lithium t…
Salts and product names
Many different lithium salts can be used as medication, including lithium carbonate, lithium acetate, lithium sulfate, lithium citrate, lithium orotate, and lithium gluconate.
Lithium carbonate (Li 2CO 3), sold under several trade names, is the most commonly prescribed, while lithium citrate (Li 3C 6H 5O 7) is also used in conventional pharmacological treatments. Lithium orotate (C 5H 3LiN 2O 4), has been presented as an alternative. Lithium bromide and lithiu…