When and How to Use Lithium Augmentation for Treating Major Depressive Disorder

Ercis, Mete; Özerdem, Ayşegül; Singh, Balwinder

doi:10.4088/jcp.23ac14813

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…28 Prescription rates for Li continue to remain relatively low in North America despite a significant evidence base favoring Li's superior efficacy and capacity to protect against neuroprogression, suicide, and all-cause mortality. [29][30][31][32][33][34][35][36][37][38] Low prescription rates for Li in the North American sites is consistent with prior literature. 9,10 This could be due to heterogeneity within BD diagnoses.…”

Section: These Differences Could Be Due To a Different Mean Age Of Pr...supporting

confidence: 86%

“…A recent Italian study demonstrated the preferential prescription of Li versus valproate for the maintenance treatment of BD among Italian early career psychiatrists 28 . Prescription rates for Li continue to remain relatively low in North America despite a significant evidence base favoring Li's superior efficacy and capacity to protect against neuroprogression, suicide, and all‐cause mortality 29–38 . Low prescription rates for Li in the North American sites is consistent with prior literature 9,10 .…”

Section: Discussionsupporting

confidence: 52%

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Patterns of pharmacotherapy for bipolar disorder: A GBC survey

et al. 2023

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ObjectivesTo understand treatment practices for bipolar disorders (BD), this study leveraged the Global Bipolar Cohort collaborative network to investigate pharmacotherapeutic treatment patterns in multiple cohorts of well‐characterized individuals with BD in North America, Europe, and Australia.MethodsData on pharmacotherapy, demographics, diagnostic subtypes, and comorbidities were provided from each participating cohort. Individual site and regional pooled proportional meta‐analyses with generalized linear mixed methods were conducted to identify prescription patterns.ResultsThis study included 10,351 individuals from North America (n = 3985), Europe (n = 3822), and Australia (n = 2544). Overall, participants were predominantly female (60%) with BD‐I (60%; vs. BD‐II = 33%). Cross‐sectionally, mood‐stabilizing anticonvulsants (44%), second‐generation antipsychotics (42%), and antidepressants (38%) were the most prescribed medications. Lithium was prescribed in 29% of patients, primarily in the Australian (31%) and European (36%) cohorts. First‐generation antipsychotics were prescribed in 24% of the European versus 1% in the North American cohort. Antidepressant prescription rates were higher in BD‐II (47%) compared to BD‐I (35%). Major limitations were significant differences among cohorts based on inclusion/exclusion criteria, data source, and time/year of enrollment into cohort.ConclusionsMood‐stabilizing anticonvulsants, second‐generation antipsychotics, and antidepressants were the most prescribed medications suggesting prescription patterns that are not necessarily guideline concordant. Significant differences exist in the prescription practices across different geographic regions, especially the underutilization of lithium in the North American cohorts and the higher utilization of first‐generation antipsychotics in the European cohorts. There is a need to conduct future longitudinal studies to further explore these differences and their impact on outcomes, and to inform and implement evidence‐based guidelines to help improve treatment practices in BD.

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Section: These Differences Could Be Due To a Different Mean Age Of Pr...supporting

confidence: 86%

Section: Discussionsupporting

confidence: 52%

Patterns of pharmacotherapy for bipolar disorder: A GBC survey

et al. 2023

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“…As mentioned, the potentiation of antidepressants in drug-resistant depression may be the second most important psychiatric indication for the use of lithium, after the prevention of BD. The indications for and performance of such a procedure have recently been discussed in detail by American authors from the Mayo Clinic (Ercis et al, 2023). Also of note is the work of German researchers indicating that this method may even be more effective in elderly people (Buspavanich et al, 2019).…”

Section: { Review Of Key Literature From 2019 To 2023 On the Use Of L...mentioning

confidence: 99%

“…Jak wspomniano, potencjalizacja leków przeciwdepresyjnych w depresji lekoopornej może stanowić drugie w kolejności, po profilaktyce ChAD, wskazanie psychiatryczne do zastosowania litu. Wskazania do takiej procedury i jej przeprowadzenie zostały ostatnio szczegółowo omówione przez autorów amerykańskich z Mayo Clinic (Ercis et al, 2023). Należy również wspomnieć o pracy badaczy niemieckich wskazujących, że metoda ta może być nawet bardziej skuteczna u osób w starszym wieku (Buspavanich et al, 2019).…”

Section: { Przegląd Najważniejszych Pozycji Piśmiennictwa Z Lat 2019-...unclassified

Lithium in mood disorders – an update

Rybakowski

2023

fpn

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in pregnancy and the postpartum period, the prevalence of lithium use and attitudes of psychiatrists towards it, and the incentives for broader lithium administration. Conclusions. The studies published between 2019 and 2023 confirmed the significant role of lithium in preventing the recurrences of mood disorders and as a therapeutic drug in acute episodes of the illness. The potentiation of antidepressants in treatment-resistant depression may constitute the second indication for lithium administration after the prevention of bipolar disorder. The optimal lithium concentration for prophylactic purposes is 0.6-0.8 mmol/l. The most important among the advant ages of long-term use of the drug are suicide prevention and a possible anti-dementia effect, but also a favourable effect on the functioning of many body systems. Adverse side effects of long-term lithium administration, including its influence on kidneys, can be minimised by appropriate application and drug monitoring. The use of lithium in pregnancy and the postpartum period seems relatively safe and therapeutically efficient. Despite the many advantages of the use of lithium in affective disorders, lithium is still underutilised, so that the therapeutic potential of the drug is not fully exploited. STRESZCZENIECel. Celem pracy jest przedstawienie najważniejszych prac klinicznych, opublikowanych w latach 2019-2023, dotyczących stosowania litu w chorobach afektywnych. Przegląd piśmiennictwa. Dokonano wyboru i omówienia piśmiennictwa, które dotyczyło takich zagadnień, jak skuteczność profilaktycznego i leczniczego działania AbSTRACTObjectives. The paper aims to present the most important clinical research on lithium in mood disorders, published between 2019 and 2023. Literature review. The bibliography was selected and discussed across such topics as prophylactic and therapeutic lithium efficacy in mood disorders, therapeutic lithium concentrations and preparations, advantages and adverse side effects of long-term lithium administration, clinical factors connected with the efficacy of long-term lithium administration, the use of lithium Review article / Artykuł przeglądowy Lithium in mood disorders -an updateLit w chorobach afektywnych -aktualizacja

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“…Here, we considered studies reporting on subtherapeutic doses of lithium when the specified range of lithium concentrations comprises blood lithium concentrations below the 0.4 mEq/l threshold. Certain lines of evidence suggest that, especially in the context of unipolar depression therapy, the minimum effective dose could be as low as 0.4 mEq/L (Ercis et al 2023 ; Taylor et al 2021 ), with possible improvements in terms of tolerability as compared with the most established target range comprised between 0.6 and 0.8 mEq/L, but at the cost of being potentially less effective as a prophylactic intervention (Taylor et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Lithium and its effects: does dose matter?

Manchia,

Paribello,

Pinna

et al. 2024

Int J Bipolar Disord

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Background Decades of clinical research have demonstrated the efficacy of lithium in treating acute episodes (both manic and depressive), as well as in preventing recurrences of bipolar disorder (BD). Specific to lithium is its antisuicidal effect, which appears to extend beyond its mood-stabilizing properties. Lithium’s clinical effectiveness is, to some extent, counterbalanced by its safety and tolerability profile. Indeed, monitoring of lithium levels is required by its narrow therapeutic index. There is consensus that adequate serum levels should be above 0.6 mEq/L to achieve clinical effectiveness. However, few data support the choice of this threshold, and increasing evidence suggests that lithium might have clinical and molecular effects at much lower concentrations. Content This narrative review is aimed at: (1) reviewing and critically interpreting the clinical evidence supporting the use of the 0.6 mEq/L threshold, (2) reporting a narrative synthesis of the evidence supporting the notion that lithium might be effective in much lower doses. Among these are epidemiological studies of lithium in water, evidence on the antisuicidal, anti-aggressive, and neuroprotective effects, including efficacy in preventing cognitive impairment progression, Alzheimer’s disease (AD), and amyotrophic lateral sclerosis (ALS), of lithium; and (3) revieweing biological data supporting clinically viable uses of lithium at low levels with the delineation of a mechanistic hypothesis surrounding its purported mechanism of action. The study selection was based on the authors’ preference, reflecting the varied and extensive expertise on the review subject, further enriched with an extensive pearl-growing strategy for relevant reviews and book sections. Conclusions Clinical and molecular effects of lithium are numerous, and its effects also appear to have a certain degree of specificity related to the dose administered. In sum, the clinical effects of lithium are maximal for mood stabilisation at concentrations higher than 0.6 mEq/l. However, lower levels may be sufficient for preventing depressive recurrences in older populations of patients, and microdoses could be effective in decreasing suicide risk, especially in patients with BD. Conversely, lithium’s ability to counteract cognitive decline appears to be exerted at subtherapeutic doses, possibly corresponding to its molecular neuroprotective effects. Indeed, lithium may reduce inflammation and induce neuroprotection even at doses several folds lower than those commonly used in clinical settings. Nevertheless, findings surrounding its purported mechanism of action are missing, and more research is needed to investigate the molecular targets of low-dose lithium adequately.

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When and How to Use Lithium Augmentation for Treating Major Depressive Disorder

Cited by 4 publications

References 21 publications

Patterns of pharmacotherapy for bipolar disorder: A GBC survey

Patterns of pharmacotherapy for bipolar disorder: A GBC survey

Lithium in mood disorders – an update

Lithium and its effects: does dose matter?

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