Does Lithium Prevent Depressions by Suppressing Manias?

Abstract

41 patients with recurrent endogenous affective disorders were given continuous lithium treatment for periods varying from 3 months to 2‘/2 years; the prophylactic action of lithium was confirmed. It was observed that a depressive episode was generally prevented or attenuated by lithium only when a preceding manic episode had been prevented or attenuated by lithium. The hypothesis of ‘subclinical’ manic phases is considered.

Memantine: A New Mood Stabilizer for Treatment-Resistant Bipolar Disorders

“…a cycle of mania-depression) in rats This observation provides strong experimental support for the hypothesis that antidepressant-induced mania/hypomania is the trigger phenomenon of rapid-cycling course (Collu et al, 1997b;Serra & D'Aquila, 2008;Serra, 2009Serra, , 2010 and that the prevention of both spontaneous or antidepressant-induced mania/hypomania (Koukopoulos & Reginaldi, 1973;Koukopoulos & Ghaemi, 2009) (in neurobiological terms, dopamine D2 receptor sensitization) is essential to avoid the development of a rapid-cycling bipolar disorder.…”

“…The prevention of mania, whether induced by antidepressants or spontaneous, is the essential element in the therapy and prophylaxis of bipolar disorders (Koukopoulos & Reginaldi, 1973;Koukopoulos & Ghaemi, 2009). When, in fact, treatments currently in use do not achieve this aim the course of the disorder becomes 'malign', i.e refractory to treatment, as in the rapid-cycling course.…”

Memantine: New prospective in bipolar disorder treatment

“…Antidepressant induced manic episodes in humans [38,41,49,50] and dopamine receptor sensitization should be considered not a mere iatrogenic phenomenon but the intensification of a spontaneous underlying hypomanic process. In fact, the conversion from unipolar to bipolar course induced by antidepressants persists also after the discontinuation of antidepressant treatment, suggesting that these drugs anticipate a natural phenomenon.…”

An Amphetamine Model of Manic Depressive Illness

“…Other workers, more recently, have also been impressed by the frequency with which depression follows mania (41,53). One study demonstrated that almost 60% of all manic attacks were followed by depression; sadness and dysphoria were frequent in the remainder but of insufficient intensity to qualify for the diagnosis of clinical depression (82).…”

“…If this can be demonstrated, it would provide an explanation for lithium's antimanic and prophylactic actions in manic-depressive illness (71). In preventing monoamine oxidase inhibition lithium also prevents its later rebound; in blocking one swing of the metabolic pendulum, lithium also blocks the other (41) (fig. 1).…”