Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Abstract

Objective: Several treatment guidelines are available for clinicians working with patients with bipolar disorder (BD), but some of the more nuanced aspects of lithium therapy go beyond the scope of such guidelines. Therefore, in this perspective, our objective was to focus on specific practical issues of lithium treatment, including the selection and initiation of long-term treatment, and management and discontinuation (if indicated) of lithium prophylaxis. Method:We conducted a focused review of the relevant literature on the treatment of BD.Results: Consultation requests to a BD specialty service often relate to issues for which there is limited evidence, including when to initiate long-term treatment, whether choice of mood stabilizer is specific, how long to treat acute episodes, whether to switch or add on medication when treatment fails, how long to continue effective treatment, and what medication to use when a lithium-responsive patient must discontinue lithium. Conclusion:Optimal long-term treatment of BD will require more research as well as better alignment of clinical and training programs. W W WObjectif : Plusieurs guides de traitement sont offerts aux cliniciens qui travaillent auprès de patients souffrant du trouble bipolaire (TB), mais certains des aspects plus nuancés de la thérapie par le lithium vont au-delà de la portée de ces guides. Par conséquent, dans cette optique, notre objectif était de mettre l'accent sur des questions pratiques spécifiques du traitement par lithium, notamment la sélection et l'initiation d'un traitement à long terme, et la gestion et l'interruption (si indiqué) d'un traitement préventif par lithium.Méthode : Nous avons mené une revue ciblée de la littérature pertinente sur le traitement du TB.Résultats : Les demandes de consultation à un service spécialisé en TB ont souvent trait aux questions pour lesquelles les données probantes sont limitées, notamment, le moment d'initier un traitement à long terme, si le choix d'un régulateur de l'humeur est spécifique, combien de temps traiter les épisodes aigus, s'il faut changer de médicament ou en ajouter lorsque le traitement échoue, combien de temps continuer un traitement efficace, et quel médicament utiliser quand un patient qui répond bien au lithium doit arrêter le lithium. Conclusion :Le traitement à long terme optimal du TB exigera plus de recherche ainsi qu'une meilleure harmonisation des programmes cliniques et de formation.

Identification of Hub Genes and Key Pathways Associated With Bipolar Disorder Based on Weighted Gene Co-expression Network Analysis

“…BD can cause circadian rhythm disturbances (Gonzalez, 2014), cognitive impairment, verbal memory loss (Cardoso et al, 2015), and increase the risk of other diseases. Suicide (Calkin and Alda, 2012) is the leading cause of death in BD patients. In one long-term study, the average suicide rate of major emotional patients was 15–20%, and while BD patients had a rate of more than 20% (Pompili et al, 2013).…”

A renoprotective role of chitosan against lithium-induced renal toxicity in rats

“…Moreover, it accumulates in marine animals, algae and vegetables which represent the primary dietary Li sources and may contribute from 66% to 90% of the total Li intake (Curran and Ravindran 2014;McCartney et al 2014). Lithium carbonate has been used as an invaluable drug to cure bipolar disorders and manic-depressive illness for more than 60 years (Grunze et al 2010;Calkin and Alda 2012;Vieta and Valenti 2013). Moreover, it was reported that this drug used as chronic treatment to prevent development of Alzheimer's disease (Forlenza et al 2011) and for treatment of refractory depression (Edwards et al 2013;Cleare et al 2015).…”

Lithium for bipolar disorder: a review of the recent literature

“…Other predictors of a favorable response to lithium recognized elsewhere in the literature include long depression-free intervals, absence of rapid cycling or comorbid substance and alcohol issues [116], a family history of lithium responders [117] and low comorbidities [10]. Greater illness severity predicts a poorer response to lithium during the maintenance phase [118].…”

“…Lack of industry research and funding due to the absence of a patent [1,8] may also have contributed to its decline. Furthermore, the expansion of the bipolar diagnosis and acceptance of 'bipolar spectrum disorders' may have resulted in lithium appearing less effective due to the increase in patients with atypical features who are less likely to respond to lithium [10].…”