Lithium in the treatment of depression

Mendels, J.

doi:10.1176/ajp.133.4.373

Cited by 139 publications

(4 citation statements)

References 40 publications

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“…The earlier studies on the efficacy of lithium against bipolar depression provided some positive data but are difficult to interpret (Goodwin et al, 1969, 1972; Greenspan et al, 1970; Stokes et al, 1971; Noyes and Dempsey, 1974; Noyes et al, 1974; Baron et al, 1975; Mendels, 1976; Donnelly et al, 1978; Srisurapanont et al, 1995). There is only one modern and rigorously conducted RCT (EMBOLDEN I) and it was negative for lithium while positive for quetiapine.…”

Section: Efficacy Datamentioning

confidence: 99%

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

Fountoulakis

Yatham

Grunze

et al. 2016

IJNPPY

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Background:The current paper includes a systematic search of the literature, a detailed presentation of the results, and a grading of treatment options in terms of efficacy and tolerability/safety.Material and Methods:The PRISMA method was used in the literature search with the combination of the words ‘bipolar,’ ‘manic,’ ‘mania,’ ‘manic depression,’ and ‘manic depressive’ with ‘randomized,’ and ‘algorithms’ with ‘mania,’ ‘manic,’ ‘bipolar,’ ‘manic-depressive,’ or ‘manic depression.’ Relevant web pages and review articles were also reviewed.Results:The current report is based on the analysis of 57 guideline papers and 531 published papers related to RCTs, reviews, posthoc, or meta-analysis papers to March 25, 2016. The specific treatment options for acute mania, mixed episodes, acute bipolar depression, maintenance phase, psychotic and mixed features, anxiety, and rapid cycling were evaluated with regards to efficacy. Existing treatment guidelines were also reviewed. Finally, Tables reflecting efficacy and recommendation levels were created that led to the development of a precise algorithm that still has to prove its feasibility in everyday clinical practice.Conclusions:A systematic literature search was conducted on the pharmacological treatment of bipolar disorder to identify all relevant random controlled trials pertaining to all aspects of bipolar disorder and graded the data according to a predetermined method to develop a precise treatment algorithm for management of various phases of bipolar disorder. It is important to note that the some of the recommendations in the treatment algorithm were based on the secondary outcome data from posthoc analyses.

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Section: Efficacy Datamentioning

confidence: 99%

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

Fountoulakis

Yatham

Grunze

et al. 2016

IJNPPY

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“…Six cross-over studies were undertaken using lithium and placebo, of which five were double-blinded (Baron et al, 1975;Goodwin et al, 1969Goodwin et al, , 1972Mendels, 1976;Stokes et al, 1971) and one was single blinded (Noyes et al, 1974) (see Table 1). These studies mostly alternated treatment with lithium and placebo, employing treatment lengths of between two and 22 days, regardless of effect.…”

Section: Cross-over Studiesmentioning

confidence: 99%

Lithium in bipolar depression: A review of the evidence

Riedinger,

van der Wee,

Giltay

et al. 2023

Human Psychopharmacology

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BackgroundLithium is widely used as treatment of acute mania and as prophylactic therapy for bipolar disorder. International and national guidelines also consider lithium as a possible treatment of acute bipolar depression. Research on the use of lithium in bipolar depression, however, seems to be limited compared to the data available for its efficacy in the other phases of bipolar disorder.ObjectiveTo provide a systematic review of the evidence for lithium in the treatment of acute bipolar depression and provide directions for further research.MethodA systematic review of clinical studies investigating the use of lithium in bipolar depression was performed using preferred reporting items for systematic reviews and meta‐analyses guidelines in Pubmed, Embase and Psychinfo using the medical subjects headings and free text terms “lithium,” “bipolar depression,” “dosage,” “serum concentration” and “bipolar disorders.”ResultsThis review included 15 studies with a total of 1222 patients, between the age of 18 and 65, suffering from bipolar depression of which 464 were treated with lithium. There are currently only limited and low‐quality data on the efficacy of lithium as a treatment of bipolar depression. It appears that there have been no placebo controlled randomized controlled trials with lithium concentrations that are considered to be therapeutic. The older studies suffered from limitations such as small sample sizes, insufficient treatment lengths, and insufficient monitoring of serum concentrations.ConclusionIn contrast to data for the treatment of mania and prophylaxis, robust data on the efficacy of lithium in bipolar depression is currently lacking, making it impossible to make conclusions regarding efficacy or inefficacy, for which further research is needed.

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“…Lithium is a naturally occurring and trace element. Because of the mood-stabilizing effects of lithium, the compound has long been used as a psychiatric medication to treat bipolar disorders and depression . Exactly how lithium affects the brain in these psychiatric disorders remains unknown but multiple intersecting mechanisms have been suggested, such as lithium’s direct inhibition of glycogen synthase kinase-3β or effects on neurotrophic factors, neurotransmitters, oxidative metabolism, apoptosis, and second messenger systems .…”

Section: Introductionmentioning

confidence: 99%

“…Because of the mood-stabilizing effects of lithium, 1,2 the compound has long been used as a psychiatric medication to treat bipolar disorders 3,4 and depression. 5,6 Exactly how lithium affects the brain in these psychiatric disorders remains unknown but multiple intersecting mechanisms have been suggested, such as lithium's direct inhibition of glycogen synthase kinase-3β or effects on neurotrophic factors, neurotransmitters, oxidative metabolism, apoptosis, and second messenger systems. [7][8][9][10][11][12][13][14] As a naturally occurring element, lithium is present in drinking water at low concentrations because of the weathering of minerals in the subsurface.…”

mentioning

confidence: 99%

Association Between Estimated Geocoded Residential Maternal Exposure to Lithium in Drinking Water and Risk for Autism Spectrum Disorder in Offspring in Denmark

Liew

Meng

et al. 2023

JAMA Pediatr

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ImportanceLithium is a naturally occurring and trace element that has mood-stabilizing effects. Maternal therapeutic use of lithium has been associated with adverse birth outcomes. In animal models, lithium modulates Wnt/β-catenin signaling that is important for neurodevelopment. It is unknown whether exposure to lithium in drinking water affects brain health in early life.ObjectiveTo evaluate whether autism spectrum disorder (ASD) in offspring is associated with maternal exposure to lithium in drinking water during pregnancy.Design, Setting and ParticipantsThis nationwide population-based case-control study in Denmark identified 8842 children diagnosed with ASD born from 2000 through 2013 and 43 864 control participants matched by birth year and sex from the Danish Medical Birth Registry. These data were analyzed from March 2021 through November 2022.ExposuresGeocoded maternal residential addresses during pregnancy were linked to lithium level (range, 0.6 to 30.7 μg/L) in drinking water estimated using kriging interpolation based on 151 waterworks measurements of lithium across all regions in Denmark.Main Outcomes and MeasuresASD diagnoses were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes recorded in the Danish Psychiatric Central Register. The study team estimated odds ratios (ORs) and 95% CIs for ASD according to estimated geocoded maternal exposure to natural source of lithium in drinking water as a continuous (per IQR) or a categorical (quartile) variable, adjusting for sociodemographic factors and ambient air pollutants levels. The study team also conducted stratified analyses by birth years, child’s sex, and urbanicity.ResultsA total of 8842 participants with ASD (male, 7009 [79.3%]) and 43 864 control participants (male, 34 749 [79.2%]) were studied. Every IQR increase in estimated geocoded maternal exposure to natural source of lithium in drinking water was associated with higher odds for ASD in offspring (OR, 1.23; 95% CI, 1.17-1.29). Elevated odds among offspring for ASD were estimated starting from the second quartile (7.36 to 12.67 μg/L) of estimated maternal exposure to drinking water with lithium and the OR for the highest quartile (more than 16.78 μg/L) compared with the reference group (less than 7.39 μg/L) was 1.46 (95% CI, 1.35-1.59). The associations were unchanged when adjusting for air pollution exposures and no differences were apparent in stratified analyses.Conclusions and RelevanceEstimated maternal prenatal exposure to lithium from naturally occurring drinking water sources in Denmark was associated with an increased ASD risk in the offspring. This study suggests that naturally occurring lithium in drinking water may be a novel environmental risk factor for ASD development that requires further scrutiny.

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Lithium in the treatment of depression

Cited by 139 publications

References 40 publications

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

Lithium in bipolar depression: A review of the evidence

Association Between Estimated Geocoded Residential Maternal Exposure to Lithium in Drinking Water and Risk for Autism Spectrum Disorder in Offspring in Denmark

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