Prospective studies on a lithium cohort

Abstract

A cohort of manic-depressive patients given prophylactic lithium treatment were examined before treatment started and at intervals during treatment for up to 7 years. The mean lithium dosage was 23.2 mmol/d and the mean serum lithium concentration 0.68 mmol/l. About 40% of the patients were entirely free of side effects, as compared with 10% among patients treated previously with higher lithium doses and serum lithium concentrations. Tremor complaints were presented by 5% of the patients before and by 15% during lithium treatment. The frequency fell with continued treatment, and after a few years it was not higher than before treatment started. Tremor complaints were positively correlated with age and with the use of neuroleptics and antidepressants. The tremorigenic effects of lithium and antidepressants seemed to potentiate each other. Tremor complaints were more frequent at serum lithium levels over than under 0.7 mmol/l. Body weight increased during the first 1-2 years of lithium treatment and then remained constant. The average gain was 4 kg. Weight gain was positively correlated with the patients' body weight before treatment and with the concurrent administration of antidepressant drugs. The frequency of diarrhea complaints (loose stools, defecation urge) rose from 1% to 6% during the first 6 months of lithium treatment and then leveled off. The frequency rose steeply at serum lithium values over 0.8 mmol/l. During lithium administration about one tenth of the patients had psychological complaints, which might or might not have been caused by the treatment: memory impairment and concentrating difficulty, tiredness and "greyness of life", in a few cases altered taste or lowered libido and potency.

Lithium side effects and toxicity: prevalence and management strategies

“…In another study, 77% of lithium-treated patients gained weight with an average increase of 6.3 kg (8% baseline body weight) (Chengappa et al 2002). These results are remarkably similar to the 73% rate of weight gain in the Aarhus clinic (Vestergaard et al 1988). Among more recent studies, mean weight change over one year in one double-blind study of lithium-treated patients was 4.2 kg (Calabrese et al 2003).…”

“…Diarrhea increases in prevalence in patients through the first 6 months of treatment and is seen in up to 10% of lithium-treated patients (Vestergaard et al 1988). Serum lithium levels >0.8 mEq/l are associated with higher rates of diarrhea (Vestergaard et al 1988).…”

“…Serum lithium levels >0.8 mEq/l are associated with higher rates of diarrhea (Vestergaard et al 1988). Some, but not all studies, suggest higher rates of diarrhea with sustained release lithium preparations, presumably due to more distal absorption of the drug (Edstrom and Persson 1977).…”

“…The severity of lithium-induced tremor is additive to other forms of physiologic tremor from etiologies such as anxiety, alcohol withdrawal, caffeine ingestion or idiopathic, familial tremor. Some studies have found additive effects from other medications such as some antidepressants (Bone et al 1980; Vestergaard et al 1988). …”

“…Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremor. The type of lithium preparation does not alter tremor prevalence but higher lithium levels correlate with greater risk of tremor (Vestergaard et al 1988). …”