Lithium: Still a Cornerstone in the Long-Term Treatment in Bipolar Disorder?

Nivoli, Alessandra; Murru, Andréa; Vieta, Eduard

doi:10.1159/000314307

Cited by 70 publications

(44 citation statements)

References 62 publications

(59 reference statements)

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“…Lithium Carbonate (Li + ) is the preferred and most efficacious therapy for acute treatment and maintenance therapy for bipolar depressive disorder, and is a useful adjunct in unipolar depression [1,2]. Long-term lithium therapy is associated with multiple endocrine and metabolic alterations such as hyperthyroidism, hypothyroidism, reduced bone mineral density (BMD), osteopenia, as well as several gastrointestinal (nausea, constipation), cardiovascular (bradyarrythmias), renal (nephrocalcinosis, reduced glomerular filtration rate (GFR), polyuria, nephrogenic diabetes insipidus) and psychosomatic adverse effects (weakness, fatigue, depression).…”

Section: Introductionmentioning

confidence: 99%

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

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Background: Long-term lithium use in psychiatric patients may lead to lithium associated hyperparathyroidism (LAH). Although anecdotal case reports have appeared, an evidence based algorithm for management of LAH is lacking. Methods: A comprehensive literature search was performed using PubMed with keywords; "lithium" "hypercalcemia" "hyperparathyroidism" "sestamibi" "intra-operative parathyroid hormone (IOPTH) monitoring" "parathyroidectomy" and "medical management". All English language publications addressing etiology and clinical management issues concerning LAH were critically analyzed. Results: Lithium associated hyperparathyroidism occurs in 4.3% -6.3% of chronic lithium users compared to the general population which has an incidence of 0.5% -1%. 194 cases of LAH have been reported which includes 10 patients (5%) treated medically and 170 patients (88%) who underwent parathyroidectomy. No details were available for 14 patients (7%). Among parathyroidectomy patients, 104 (59%) had adenomatous disease and 66 (39%) had multiglandular hyperplasia. Preoperative localization studies were utilized in only 22 patients (13%) and IOPTH monitoring was reported in only 3 studies (32 patients, 19%). Among surgical patients, bilateral neck exploration (BNE) was the most common approach performed in 162 patients (95%); focused neck exploration was utilized in only 8 patients (5%). Parathyroidectomy normalized LAH biochemical changes in nearly all patients (90% -97%) in the early post-operative period, but recurrent hyperparathyroidism occurred in 8% -42% of patients. Conclusion: LAH is an under appreciated and poorly understood endocrine disorder. LAH has a higher incidence of multiglandular disease and bilateral neck exploration is mandatory in majority for disease control. Nonsurgical approaches may be useful in select patients on short-term lithium therapy.

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Section: Introductionmentioning

confidence: 99%

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

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“…Therefore, we suggest that increased expression of these proteins, particularly in the control state, reduces Na ϩ delivery to the distal nephron and provides a buffer to attenuate collecting duct-mediated natriuresis and kaliuresis. Additional studies are warranted to explore the potential therapeutic benefits of purinergic antagonism.vasopressin; aldosterone; sodium transporters; epithelial sodium channel; potassium channels; ATP; nephrogenic diabetes insipidus DESPITE THE ADVENT of newer medications, lithium continues to be the main choice for the treatment of bipolar disorder due to its ability to prevent suicidal tendencies (12,24). However, the adverse effects of chronic lithium treatment on the kidney leading to nephrogenic diabetes insipidus (NDI) is a major limiting factor in the use of this effective medication (for a review, see Ref.…”

mentioning

confidence: 99%

“…DESPITE THE ADVENT of newer medications, lithium continues to be the main choice for the treatment of bipolar disorder due to its ability to prevent suicidal tendencies (12,24). However, the adverse effects of chronic lithium treatment on the kidney leading to nephrogenic diabetes insipidus (NDI) is a major limiting factor in the use of this effective medication (for a review, see Ref.…”

mentioning

confidence: 99%

Attenuation of lithium-induced natriuresis and kaliuresis in P2Y₂receptor knockout mice

Zhang

Kohan

et al. 2013

American Journal of Physiology-Renal Physiology

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receptor activity and increased renal Na ϩ conservation. We hypothesized that P2Y2R KO mice would be less sensitive to lithiuminduced natriuresis and kaliuresis due to attenuated downregulation of one or more of the major renal Na ϩ or K ϩ transporter/channel proteins. KO and wild-type (WT) mice were fed a control or lithiumadded diet (40 mmol/kg food) for 14 days. Lithium-induced natriuresis and kaliuresis were significantly (ϳ25%) attenuated in KO mice. The subunits of the epithelial Na ϩ channel (ENaC) were variably affected by lithium and genotype, but, overall, medullary levels were decreased substantially by lithium (15-60%) in both genotypes. In contrast, cortical, ␤-, and ␥-ENaC were increased by lithium (ϳ50%), but only in WT mice. Moreover, an assessment of ENaC activity by benzamil sensitivity suggested that lithium increased ENaC activity in WT mice but in not KO mice. In contrast, medullary levels of Na ϩ -K ϩ -2Cl Ϫ cotransporter 2 and cortical levels of the renal outer medullary K ϩ channel were not downregulated by lithium and were significantly (15-76%) higher in KO mice under both dietary conditions. In addition, under control conditions, tissue osmolality of the inner medulla as well as furosemide sensitivity were significantly higher in KO mice versus WT mice. Therefore, we suggest that increased expression of these proteins, particularly in the control state, reduces Na ϩ delivery to the distal nephron and provides a buffer to attenuate collecting duct-mediated natriuresis and kaliuresis. Additional studies are warranted to explore the potential therapeutic benefits of purinergic antagonism.vasopressin; aldosterone; sodium transporters; epithelial sodium channel; potassium channels; ATP; nephrogenic diabetes insipidus DESPITE THE ADVENT of newer medications, lithium continues to be the main choice for the treatment of bipolar disorder due to its ability to prevent suicidal tendencies (12,24). However, the adverse effects of chronic lithium treatment on the kidney leading to nephrogenic diabetes insipidus (NDI) is a major limiting factor in the use of this effective medication (for a review, see Ref. 11). In addition, lithium has been shown to have a myriad of other effects in the kidney (for a review, see Ref. 15). Clinically, lithium-induced NDI is characterized by polyuria, natriuresis, and kaliuresis as well as the loss of other vital substances in the urine. Arginine vasopressin (AVP)-resistant polyuria causes dehydration, hypovolemia, and hypernatremia, leading to hemodynamic instability in elderly patients (23). On the other hand, lithium-induced natriuresis and kaliuresis activate mechanisms that result in renal lithium retention and lithium intoxication, which can become a vicious cycle (1, 34). Currently used therapeutic measures for lithiuminduced NDI, such as the use of cyclooxygenase (COX) inhibitors or thiazides, can also cause lithium intoxication, thus limiting their clinical use (25,35). Although administration of amiloride ameliorated lithium-induced polyuria, it markedly en...

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“…Lithium still remains as a cornerstone in the long-term treatment of bipolar disorder (Nivoli et al 2010). Lithium is more effective than placebo in preventing all relapses and especially manic relapses.…”

Section: Lithiummentioning

confidence: 99%

“…Compared with other mood stabilising agents, Lithium is less effective than Valproate and Olanzapine in preventing manic or mixed episodes and less effective than Lamotrigine in preventing depressive episodes. Its efficacy is similar to Carbamazepine in both acute and long-term treatment (Nivoli et al 2010). Lithium has been effective in preventing suicide, deliberate self-harm and reduces mortality from all causes in bipolar patients (Cipriani et al 2005).…”

Section: Lithiummentioning

confidence: 99%