If a doctor has prescribed lithium for you or someone close to you, you maywish to know more about the medication Is it safe? Will it cause discomfort?Most importantly, will it work? Chances are you’ve been told hat lithium mayprevent future bouts of your illness. You can benefit from this remarkableeffect only if you continue to take the drug exactly as the doctor prescribes. You may have to take it for long periods of time, perhaps indefinitely. That means lithium is as important to you as insulin is to adiabetic or other kinds of daily medications are to people with high bloodpressure. If you want to learn a bit more about this medication, here´s a bit of info about it, specially when it is used to treat bipolar disorder and to prevent suicide attemps.

History

Lithium’s effect on mood stabilization was first discovered by John Frederick Joseph Cade, and was published September 1949 in the Medical Journal of Australia. Cade was testing the effect of uric acid on mice. Because uric acid is insoluble, Cade chose the most soluble salt of it, lithium ureate. He discovered this compound had a calming effect on mice. After extensive testing, he discovered that while lithium had little effect on depressed patients, manic patients became much calmer after lithium use.

Treatment

Initially, lithium is often used in conjunction with antipsychotic drugs as it can take up to a week for lithium to have an effect. Lithium is also used as prophylaxis for depression and mania in bipolar disorder. Also, it is sometimes used for other disorders, like cycloid psychosis, unipolar depression, migraine and others. It is sometimes used as an “augmenting” agent, to increase the benefits of standard drugs used for unipolar depression. Lithium treatment was previously considered to be unsuitable for children, however more recent studies show its effectiveness for treatment of early-onset bipolar disorder in children as young as eight. administered, it is one of the most powerful medications available for mood disorders.

Uses

Manic and Depressive Episodes

Lithium is highly effective in treating acute episodes of mania, especially when symptoms are mild. Patients going through severe manic episodes need to be calmed as quickly as possible, however, and lithium may take 1 to 3 weeks to achieve its full effect. Therefore, physicians most often treat very disturbed patients by first combining lithium with a different type of drug, a tranquilizer, such as haloperidol or chlorpromazine. When lithium has had a chance to act, the tranquilizer may be gradually withdrawn. Lithium can normalize the manic disorder without causing the drugged feeling that often occurs with tranquilizers. Also, tranquilizers may produce troublesome side effects that limit their usefulness as a long-term treatment. Lithium is also effective in treating depressive episodes in some patients with manic-depressive illness. For these patients, some doctors prefer to treat mild to moderate depressive episodes with lithium alone because of the possibility that conventional anti-depressant drugs such as imipramine may trigger a hypomanic or manic attack. If the depression is severe, treatment is usually begun with a conventional antidepressant in combination with lithium. That same combination is sometimes used in unipolar depressions that do not respond to anti- depressant medications alone.

Lithium’s Role in Preventing Manic and Depressive Episodes

As noted, lithium’s greatest value is in preventing or reducing the occurrence of future episodes of bipolar disorder. The effectiveness of this lithium prophylaxis or lithium prophylactic treatment has been demonstrated in more than two decades of careful research. In related research, several major studies indicate that lithium can decrease the frequency or severity of new depressive episodes in recurrent unipolar disorder. This suggests that lithium may also have prophylactic value in treating this mood disorder. Conventional antidepressants also have been shown to be effective prophylactic treatment for recurrent unipolar depression. In prophylactic treatment, lithium is administered after a manic or depressive episode to prevent or dampen future attacks. Some patients respond quickly and have no further episodes. Others respond more slowly and continue to have moderate mood swings even months after therapy is started. These highs or lows usually become progressively less severe with continued lithium treatment; often they disappear. With other patients, lithium may not prevent all future manic and depressive episodes, but may reduce or lessen their severity so that the individual can continue to lead a productive life. There are patients who are not helped at all by lithium. About one in ten patients with bipolar disorder who takes lithium does not respond to the medication, but continues to have manic-depressive episodes at the same frequency and severity as before. Doctors cannot predict with certainty how lithium will work in any individual case. This can be determined only by actual use of the medication. When deciding whether a patient should start lithium prophylactic therapy, a psychiatrist or other physician considers the likelihood of a new episode in the near future; the impact that the episode might have on the patient, family, and job; the patient’s willingness to commit himself or herself to a long-term treatment program; and the presence of medical conditions that may rule out lithium treatment. Usually, a doctor prescribes lithium prophylactic therapy only after a patient has had two or three well-defined episodes requiring treatment. Patients who have had only a single attack, mild attacks, or a long interval between episodes-for example, over 5 years-usually do not receive prophylactic treatment unless the second episode would be life threatening or highly disruptive to the patient’s career or family relations. Such rules, though, serve as only broad guidelines. Patients must act as the doctor’s partner in weighing the circumstances and making the decision. Each patient should understand the reasons for lithium prophylaxis is as well as the benefits and risks and be an informed participant in the treatment program. When lithium fails or when a patient has another medical condition that precludes its use, the doctor may consider an alternative prophylactic drug treatment. First, however, he or she will reevaluate why lithium failed: Was dosage adequate? Did the patient take the medication as prescribed? Does the patient have a problem with thyroid function? Many patients with mood disorders have malfunctioning thyroid glands, a problem that can be successfully treated with a thyroid hormone or related preparations without withdrawing lithium. For manic-depressive patients, the anticonvulsant drugs carbamazepine (trade name Tegretol) and valproate (trade name Depakote) seem to be the best alternatives to lithium. Sometimes the anticonvulsant drugs are given alone, sometimes in combination with lithium, to prevent or dampen future episodes. Patients with unipolar disorder who fail on lithium often are given an antidepressant drug alone or in combination with lithium. A severe episode may be treated with electroconvulsive therapy. Information on alternatives to lithium treatment can be found in the literature listed at the end of the pamphlet.

Other Uses for Lithium

One of the other uses fro lithium treatment is in the treatment of suicide. This is mainly because of the close link between suicide and bipolar disorder. The suicide rate for those with bipolar disorder is approximately 20 percent. On average, lithium reduces suicide risk by at least six fold, while abrupt stoppage of treatment greatly increases suicide risk.
Lithium’s effect on AIDS is currently being studied by Vincent S. Gallicchio, Ph.D., director of international education at the University of Kentucky Chandler Medical Center. Combining lithium with AZT (Zidovudine) could cause fewer toxic effects and, by boosting immunity, could reduce the amount of virus in the body. The size and properties of lithium allow it to enter the cell nuclei and thus influence DNA. If lithium were found effective, says Gallicchio, “it would be ideal for use in poor countries where the disease is endemic and where governments can’t afford to provide expensive antiviral treatment.”
Other studies currently being conducted are looking at lithium treatment of cancer because lithium increases white blood cell count, helping to stave off the effects of radiation and chemotherapy.

Lithium toxicity and side effects

The required dosage (15-20mg per kg of body weight) is slightly less than the toxic level, requiring blood levels of lithium to be monitored extremely closely during treatment. In order to prescribe the correct dosage, the patient’s entire medical history, both physical and psychological, is taken into consideration. Blood tests are carried out every 3 months to ensure the level of lithium is appropriate and to prevent toxicity, along with kidney and thyroid tests.
Those who use lithium should receive regular (generally monthly once stable) blood tests and should monitor thyroid function annually and kidney function every three to six months for abnormalities. As it interferes with the regulation of sodium and water levels in the body, lithium can cause dehydration. Dehydration, which is compounded by heat, can result in increasing lithium levels.
High doses of haloperidol, fluphenazine, or flupenthixol may be hazardous when used with lithium; irreversible toxic encephalopathy has been reported.
Lithium salts, with the possible exception of lithium orotate, have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring plasma concentrations are available. Patients should be carefully selected. Doses are adjusted to achieve plasma concentrations of 0.6 to 1.2mmol Li+/litre (lower end of the range for maintenance therapy and elderly patients, higher end for pediatric patients) on samples taken 12 hours after the preceding dose. Overdosage, usually with plasma concentrations over 1.5mmol Li+/litre, may be fatal and toxic effects include tremor, ataxia, dysarthria, nystagmus, renal impairment, and convulsions. If these potentially hazardous signs occur, treatment should be stopped, plasma lithium concentrations redetermined, and steps taken to reverse lithium toxicity.
Lithium toxicity is compounded by sodium depletion. Concurrent use of diuretics that inhibit the uptake of sodium by the distal tubule (e.g. thiazides) is hazardous and should be avoided. In mild cases withdrawal of lithium and administration of generous amounts of sodium and fluid will reverse the toxicity. Plasma concentrations in excess of 2.5 mmol Li+/litre are usually associated with serious toxicity requiring emergency treatment. When toxic concentrations are reached there may be a delay of 1 or 2 days before maximum toxicity occurs.
In long-term use, therapeutic concentrations of lithium have been thought to cause histological and functional changes in the kidney. The significance of such changes is not clear but is of sufficient concern to discourage long-term use of lithium unless it is definitely indicated. An important consequence is the development of diabetes insipidus (inability to concentrate urine). Patients should therefore be maintained on lithium treatment after 3-5 years only if, on assessment, benefit persists. Conventional and sustained-release tablets are available. Preparations vary widely in bioavailability, and a change in the formulation used requires the same precautions as initiation of treatment. There are few reasons to prefer any one simple salt of lithium; the carbonate has been the more widely used, but the citrate is also available.

Lithium insertion in rock and roll culture

Among many other song that talk among drugs, various artists have spent their time using their inspiration to compose songs realted to this element. You can find Kurt Cobain´s (from Nirvana) interpretation of mood changes in his song “lithium” where he says:

“I’m so lonely, but that’s okay, I shaved my head …
And I’m not sad
And just maybe I’m to blame for all I’ve heard …
But I’m not sure
I’m so excited, I can’t wait to meet you there …
But I don’t care
I’m so horny, but that’s okay …
My will is good
Yeah Yeah Yeah (x6)

I like it – I’m not gonna crack
I miss you – I’m not gonna crack
I love you – I’m not gonna crack
I killed you – I’m not gonna crack”

Also, there is Evanescense interpretation, where Amy Lee metaphorically says:

“Lithium- don’t want to lock me up inside
lithium- don’t want to forget how it feels without
lithium- I want to stay in love with my sorrow

Don’t want to let it lay me down this time
drown my will to fly
here in the darkness I know myself
can’t break free until I let it go
let me go”
Sources: wikipedia, essortment.com, bipolarbrain.com

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