Lithium in prophylactic therapy of manic-depressive illness: Biochemical correlates of response

Upadhyaya, Ajaya K.; Varma, Vijoy K.; Sankaranarayanan, A; Goel, Animesh

doi:10.1016/0006-3223(85)90083-6

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…Many others attempted to discover a laboratory marker of lithium response, with similar outcomes. From a wealth of reports, we have included a few illustrations: lithium transport in red blood cells (30), an RBC/plasma lithium ratio (31), urinary lithium excretion (32), platelet monoaminoxidase activity (33), urinary MHPG and other expressions of central amine metabolism (34), serum calcium and magnesium (35, 36), average evoked potentials (37, 38) and HLA antigens (39). As one example of recent studies, an investigation by Kruger et al.…”

Section: Resultsmentioning

confidence: 99%

Lithium response across generations

Grof

Duffy

Alda

et al. 2009

Acta Psychiatr Scand

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Objective: To describe and integrate observations from bipolar patients responsive to lithium stabilization and their children. Method: Selected findings are described from the clinical and biological investigations of adults meeting research criteria for bipolar disorder and for responsiveness to lithium stabilization; and from prospective studies of the children of lithium responders and non‐responders. Results: Response to prophylactic lithium identifies a valid subtype of bipolar disorder, however the search for biological markers of lithium response, while promising, has so far remained inconclusive. Adult responders to lithium stabilization exhibit definable clinical features which are also observable in their affected children. In prospective studies the children of bipolar parents develop symptoms earlier than reported previously, with marked differences between the offspring of lithium responders and non‐responders. The illness evolves in predictable clinical stages, first from non‐specific sleep and anxiety disorders to mood symptoms and then, often starting in adolescence, major depressive and later activated episodes. Conclusion: Investigating and comparing unequivocal responders and non‐responders to long‐term lithium treatment and their offspring is a fertile research strategy for addressing a multitude of clinical and research questions.

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Section: Resultsmentioning

confidence: 99%

Lithium response across generations

Grof

Duffy

Alda

et al. 2009

Acta Psychiatr Scand

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“…Some of the domains of intense search have been lithium transport in red blood cells [35] , a red blood cell/ plasma lithium ratio [36] , urinary lithium excretion [37] , platelet monoamine oxidase activity [38] , urinary 3-methoxy-4-hydroxyphenylglycol and other expressions of central amine metabolism [39,40] , serum calcium and magnesium [41] , average evoked potentials [42,43] and human leukocyte antigens [44,45] . As one example of recent studies, in an investigation by Kruger et al [46] comparing regional cerebral blood flow in valproate responders, lithium responders and their unaffected rela-tives showed significant, possibly heritable differences between the two patient groups.…”

Section: Tussle To Find a Biological Marker Of Responsementioning

confidence: 99%

Sixty Years of Lithium Responders

Grof¹

2010

Neuropsychobiology

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It has been 60 years since Cade first described patients who responded to antimanic lithium treatment. Two decades later, responders to lithium stabilization emerged in larger numbers. The responses of many severely ill bipolar patients to lithium were striking and called for an explanation. Remarkable reactions to a simple ion generated hope for an uncomplicated laboratory test of response and an extensive search for suitable biological markers ensued. But despite promising reports, particularly from molecular genetics, we are still waiting for a biological elucidation of the stabilizing effects of lithium. The most useful predictor of lithium stabilization has to date been the patient’s clinical profile, based on a comprehensive clinical assessment: complete remissions and other characteristics of episodic clinical course, bipolar family history, low psychiatric comorbidity and a characteristic presenting psychopathology. In brief, the responders approximate the classical Kraepelinian description of a manic-depressive patient. But the most intriguing findings have recently emerged from prospective observations of the next generation: the children of lithium responders, their counterparts coming from parents who did not respond to lithium and controls. Overall, they indicate that parents and offspring suffer from a comparable brain dysfunction that manifests clinically in distinct stages. If the child’s predicament starts early in childhood, it presents with varied, nonaffective or subclinical manifestations that are usually nonresponsive to standard treatments prescribed according to the symptoms. The next stage then unfolds in adolescence, first with depressive and later with activated episodes. The observations have a potential to markedly enrich the prevailing understanding and management of mood disorders.

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“…In addition, several groups of investigators have reported that patients who showed a good response to Li + had higher erythrocyte Li + concentrations and higher Li + ratios than those who did not respond as well (28)(29)(30)(31)(32)(33). Perhaps the neuroleptic group had lower Li + ratios because they were not good responders and therefore required additional neuroleptic drugs.…”

Section: Discussionmentioning

confidence: 99%

The effect of concomitant use of neuroleptic drugs and lithium on the erythrocyte/plasma lithium ratio in Iranian patients with bipolar disorder

et al. 1996

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Patients treated with lithium (Li+) and neuroleptic drugs concomitantly are reported to show more pronounced adverse effects than patients on Li+ alone. There are conflicting results about the effect of neuroleptic drugs on the erythrocyte/plasma Li+ ratio and intraerythrocyte Li+ concentration, and methodological problems may be a reason for this. The effect of the concurrent use of neuroleptic drugs with Li+ on the Li+ ratio was studied in 66 patients with bipolar affective disorders during prophylactic Li+ therapy using the new direct method of measuring erythrocyte Li+ concentration. This new direct method has been shown to give much more precise and accurate results than the values obtained by other methods. No relationship was found between the Li+ ratio and sex, age, Li+ dosage, duration of treatment or plasma Li+ concentration. Results revealed that patients taking a combination of Li+ and neuroleptic drugs showed significantly lower Li+ ratios and intraerythrocyte Li+ concentrations as compared with those on Li+ alone. It is notable that this reducing effect of neuroleptic drugs was increased by the concurrent use of two types of neuroleptic drugs. The effect on neuroleptic drugs on the Li+ ratio may be mediated through a stabilizing effect of these drugs on the cell membrane and consequently Li+ transport in erythrocytes.

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Lithium in prophylactic therapy of manic-depressive illness: Biochemical correlates of response

Cited by 10 publications

References 7 publications

Lithium response across generations

Lithium response across generations

Sixty Years of Lithium Responders

The effect of concomitant use of neuroleptic drugs and lithium on the erythrocyte/plasma lithium ratio in Iranian patients with bipolar disorder

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