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PubMed1995

Lithium prophylaxis of manic-depressive disorder: daily lithium dosing schedule versus every second day.

The prophylactic efficacy of lithium carbonate given every second day versus daily intake was compared in a double-blind study including 50 manic-depressive patients. The patients met the DSM-III-R criteria for bipolar disorder or depressive disorder; according to ICD-8 the patients fulfilled criteria for manic-depressive disorder: All patients had experienced at least 3 episodes of mania or major depression, and all had been euthymic for at least 4 months. The median doses of lithium carbonate given were 800 mg/day or 1200 mg/every second day corresponding to median 12-h serum lithium concentrations of 0.6 mmol/l or 0.7 mmol/l, respectively. Manic or depressive relapse was defined as DSM-III-R criteria for mania or major depression, and a score > or = 10 on the Bech-Rafaelsen Mania Scale or the Bech-Rafaelsen Melancholia Scale, respectively. The two treatment schedules were allocated at random. Using the Cox proportional hazard model for statistical analysis, the lithium dosing schedule of every second day did not maintain its prophylactic efficacy against recurrent episodes of manic-depressive disorder. The risk of relapse increased 3 times when the interval between intake of lithium was extended from 1 to 2 days.

Adult↗

PubMed1983

Cyclic AMP phosphodiesterase activity in rat brain following chronic treatment with lithium, imipramine, reserpine, and combinations of lithium with imipramine or reserpine.

The adaptability of the cyclic AMP phosphodiesterase (PDE) following chronic treatment (4-6 weeks) with lithium, reserpine, imipramine, and combinations of lithium with imipramine or reserpine has been studied in rat brain tissue. All drugs, except lithium, were given intraperitoneally once a day. Control animals received only vehicle. Lithium was given in the diet in a concentration yielding a plasma level of 0.5-0.6 mmol/l. The PDE activity was measured in homogenates from cerebral cortex and "limbic" forebrain. These two brain areas were both found to contain three types of PDE activity. One was mainly associated with the pellet after a 10,000 X g centrifugation for 10 min. This enzyme hydrolyzed both cyclic AMP and cyclic GMP with a Km value of 130 +/- 48 microM for cyclic AMP, but was insensitive to calcium and calmodulin. Two types were mainly found in the supernatant after the centrifugation with Km values cyclic AMP of 300 +/- 108 microM and 4 +/- 3 microM, respectively. The former hydrolyzed both cyclic AMP and cyclic GMP and was stimulated 7-fold by calcium and calmodulin, while the latter only hydrolyzed cyclic AMP and was insensitive to calcium and calmodulin. None of the treatments affected the "pellet" enzyme or the low affinity enzyme from the supernatant. However, lithium treatment, even combined with reserpine or imipramine, increased the high affinity enzyme. This increase was also apparent in the DEAE-ion exchange chromatographic profile of the PDE enzymes.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed1984

No change in rat cerebral cortex calmodulin content following chronic treatment with lithium, reserpine, imipramine, and lithium combined with reserpine or imipramine.

Rats were treated 2-3 weeks with lithium, reserpine, imipramine, and combinations of lithium with reserpine or imipramine. Lithium was given in the diet, while the other drugs were dissolved in 0.9% saline and given intraperitoneally twice daily. The control and lithium groups received only vehicle injections. Twenty-four hours after the last injection the rats were decapitated and the cerebral cortex dissected. The tissue was sliced and the noradrenaline-stimulated cyclic AMP accumulation determined or the tissue was homogenized and centrifuged at 10,000 X g for 30 min. and the calmodulin content determined in the pellet and the supernatant. Reserpine treatment was found to cause an 50% increase in the noradrenaline-stimulated cyclic AMP accumulation, while treatment with imipramine and the combination lithium-imipramine decreased the noradrenaline-stimulated cyclic AMP accumulation by 40%. The tissue content of calmodulin was, however, found unaltered by all treatments.

Animals↗

PubMed1975

The relationship of plasma to erythrocyte lithium levels in patients taking lithium carbonate.

Plasma and erythrocyte lithium levels have been determined repeatedly in twelve patients taking lithium carbonate for affective disorders. In any individual the plot of the plasma lithium level against erythrocyte/plasma ratio is linear, but the ratio can either increase or decrease with increasing plasma lithium concentration. Erythrocyte/plasma ratio is an unsound basis for comparing individual responses to lithium.

Adult↗

PubMed1987

Lithium in depression: a review of the antidepressant and prophylactic effects of lithium.

The therapeutic effects of lithium in depression are reviewed. The acute antidepressant effect of lithium alone is neither as impressive nor as predictable as its antimanic action, nor is it equivalent to that of tricyclic antidepressants. In patients who are 'refractory' to tricyclics or monoamine oxidase inhibitors, combined treatment with lithium may augment antidepressant response. Lithium is an effective prophylactic treatment in both unipolar and bipolar disorder and in the latter is the drug of choice. Aspects of monitoring, such as range of therapeutic plasma levels, dosage regimen and adverse effects, are discussed. Current evidence suggests that, in patients who fail to respond to lithium or are unable to tolerate side-effects, carbamazepine should be considered.

Antidepressive Agents↗

PubMed1993

When should dialysis be performed in lithium poisoning? A kinetic study in 14 cases of lithium poisoning.

Lithium kinetics were studied in 14 patients with lithium poisoning. Three patients were treated by hemodialysis. Serum lithium peak concentrations ranged between 1.4 and 9.6 mmol/L. The apparent mean serum half-life was 23.16 +/- 9 h, the mean total clearance was 26.5 +/- 13.3 mL/min and the mean renal clearance was 17.2 +/- 5.4 mL/min. The kinetic parameters were dependent on the duration of the study and on the type of the poisoning: acute, acute upon chronic or chronic. During the first 12 h after admission ten patients were in a distribution phase, three were in an elimination phase and one was in an absorption phase. The serum half-life during hemodialysis ranged from 3.6 to 5.7 h and hemodialysis clearance was 63.2 to 114.4 mL/min. The mean volume of distribution calculated in six cases was 0.63 +/- 0.09 L/kg. The evolution of the lithium pools showed a different kinetic pattern between the extra- and the intracellular pool which decreased more slowly. During hemodialysis the decrease of the extracellular pool was about twice that of the cellular pool. Among the factors which may modify lithium toxicity and kinetics, are the type of the poisoning, the presence of an underlying disease and renal impairment. No general and rigid indication for hemodialysis can be set, but the need for hemodialysis should be based on clinical and kinetic data determined during the 12 h following admission.

Adolescent↗

PubMed1979

[Lithium and thyroid function. Significance of the TRH test in the diagnosis of lithium-induced thyroid dysfunction].

The treatment by lithium is known to involve certain endocrine complications. Those concerning the thyroid function, with risk of a frank hypothyroidy, are the most important. Aiming to appreciate the frequence and the intensivity of the endocrine effects of lithium, the thyroid parameters and the steady state of the hypothalamo-pituitary-thyroid axis were tested using the TRH test in 52 patients with maniaco-depressive psychosis with special attention to TSH, prolactin and growth hormone: 24 out of them were treated for 1 month to 6 years by lithium; the 28 others were considered as controls. The lithium treatment involves a decrease in the free thyroxine index (1.78 +/- 0.09 vs 2.16 +/- 0.09; p less than 0.01), an increase in the mean baseline TSH level (5.80 +/- 1.49 vs 2.70 +/- 0.24 microU/ml; p less than 0.05) and a noteworthy increase in the TSH responsiveness to TRH (22.7 +/- 2.14 vs 9.75 +/- 1.63 microU/ml; p less than 0.005). The TSH supranormal responses were neither correlated with the length of the treatment nor with the age of the patients. They appear as the consequence of a decrease in the thyroidal hormone secretion. The basal and stimulated prolactinemias remain comparable in the two groups of patients and no response of growth hormone occured after TRH. The TRH test must be considered as a useful complement for the surveillance of the patients treated with lithium because it permits to diagnose early the lithio-induced thyroid dysfunction.

Adolescent↗

PubMed2004

[Neuroprotection of lithium and the antagonism of lithium to toxic effects of lead on primary culturing cerebrocortical neurons in vitro].

OBJECTIVE: To investigate the toxic effects of lead on nervous system and the neuroprotection of lithium, we observed the impact of different dose of lead on the growth and survival of primary cultured cerebrocortical neurons, and the antagonism of lithium to lead. METHODS: We established the technique of primary culturing cerebrocortical neurons of newborn rats with serum-free medium. We observed the growth and survival of neurons treated with different dose of lead and 5 mmol/L lithium chloride through microscope, and measured the length of neuritis, we also compared the cell viabilities by MTT reduction assay. RESULTS: Lead could limit the growth of neurons, shorten the neuritis, and decrease the neurons viability (P < 0.01). Lithium chloride (5 mmol/L) had significant protective action on the neurons treated with lead. The length of neuritis were longer than that of the groups treated only with lead (10(-6) mol/L and 10(-5) mmol/L) (P < 0.01), and the neurons viability was also higher than that of groups treated with lead (10(-8)-10(-5) mol/L) (P < 0.01). CONCLUSION: Lead had the toxic effects on neurons, and lithium could protect the neurons against the toxicity of lead.

Animals↗

PubMed2006

[Comparison of the effectiveness of two treatment strategies in inpatients with a depressive disorder. A double-blind study of imipramine followed by lithium addition versus fluvoxamine followed by lithium addition].

BACKGROUND: There is still uncertainty regarding the best treatment optionfor depressed inpatients and the best strategy to follow if patient response is insufficient. AIM: To compare the efficacy of imipramine and fluvoxamine in depressed inpatients who subsequently received lithium supplement in case of poor response. METHOD: After a drug-free period and four days of placebo use, patients were randomised either to imipramine or to fluvoxamine (phase 1); the antidepressant dosage was fixed according to a predetermined plasma level. The efficacy of the antidepressant was evaluated four weeks after the predetermined plasma level had been attained. If patient response was inadequate, the antidepressant was augmented with lithium (phase 2). Patient response to the lithium addition was evaluated three weeks after an adequate lithium level had been attained. RESULTS: The study involved 138 inpatients. At the end of phase 1, imipramine was found to be superior tofluvoxamine according to the Clinical Global Impression of Improvement. Remission was achieved by 6 (23%) patients on imipramine and by 10 (15%) patients on fluvoxamine; this difference was not statistically significant. At the end of phase 2, 41 (9%) patients on imipramine and 27 (40%) patients on fluvoxamine achieved remission, this significant difference demonstrating the superiority of the imipramine strategy. CONCLUSION: Imipramine with subsequent lithium addition is superior to a similar strategy with fluvoxamine.

Adult↗

PubMed1991

Compliance during lithium treatment, intra-erythrocyte lithium variability, and relapse.

Differential lithium concentrations across the erythrocyte (RBC) membrane have been studied in the search for biological markers in the affective disorders. The methodologic problems of these studies are reviewed with particular reference to compliance effects. We assessed a triad of compliance parameters, including RBC lithium variability, in a group of 60 lithium clinic attenders, in relation to relapse data and diagnostic subgroups. It was found that RBC lithium variability, used in the present study for the first time, related to higher relapse rates on lithium, suggesting that it may be used as an objective medium term compliance parameter. The established patterns of compliance were compared for the diagnostic subgroups.

Bipolar Disorder↗

PubMed1981

Urinary osmolality in lithium and non-lithium treated psychiatric patients.

A study was conducted to determine the prevalence of urine concentrating defect in 57 psychiatric patients who were treated with lithium and 42 patients who were not treated with lithium. Analysis of results indicated that there was no statistically significant difference between the lithium treated and control groups in their random 12 hour fluid deprivation urine osmolality, 0.5 greater than p greater than 0.1, t-test. The authors suggest that impaired urinary concentrating ability occurs frequently in both lithium and nonlithium treated psychiatric patients. This isolated finding alone is insufficient to warrant the diagnosis of lithium nephrotoxicity.

Diabetes Insipidus↗

PubMed1980

Interaction of indomethacin and ibuprofen with lithium in manic patients under a steady-state lithium level.

The clinical effects of prostaglandin synthesis inhibitors were studied in lithium treated manic patients. While indomethacin increased plasma lithium concentration, the effect of ibuprofen was inconsistent. Adverse reactions included tremors unrelated to changes in plasma lithium levels; nausea and drowsiness in 1 ibuprofen treated patient possibly related to the slight increase in plasma lithium, and a syndrome consisting of running nose, malaise and generalized body aches in 1 indomethacin treated patient. Our findings are in support of an important interaction between prostaglandin synthesis inhibitors and especially indomethacin and lithium, which may result in an increase in adverse reactions.

Adult↗

PubMed1994

Relationship of lithium concentrations in the brain measured by lithium-7 magnetic resonance spectroscopy to treatment response in mania.

Lithium concentrations in the brain were measured in 14 manic patients with bipolar disorder (12 with bipolar disorder, manic, and 2 with bipolar disorder, not otherwise specified, by DSM-III-R) by the use of lithium-7 magnetic resonance spectroscopy ([7Li]MRS). The reduction of Petterson Mania Rating Scale 4 weeks after the initiation of lithium treatment was not significantly correlated with concentrations in serum (r = 0.33), but was correlated with concentrations in the brain (r = 0.64; p < 0.05). These results suggest that the treatment response to lithium in manic patients with bipolar disorder is more closely related to the lithium concentration in the brain as measured by [7Li]MRS than to the concentration in serum.

Adult↗

PubMed1975

[The significance of the serum lithium level for lithium therapy of phasic psychoses (author's transl)].

Lithium is an effective substance for the treatment of frequently recurring manias and depressions. But its use requires some precautionary measures which must be carefully attended to. Thus, the initial dose must be low. Then the serum lithium level must be determined after one week. The best time to take the blood sample is about 12 hours after the last dose of lithium. The dosage is adjusted according to the serum lithium level. Subsequent adjustments are frequently necessary during the first few weeks of treatment until the optimal serum lithium level for the individual patient has been found.

Age Factors↗

PubMed2004

Perturbation of conjugation in allylic lithium compounds due to stereochemical control of internal lithium coordination: crystallography, NMR, and calculational studies.

Several allylic lithium compounds have been prepared with ligands tethered at C(2). These are with (CH(3)OCH(2)CH(2))(2)NCH(2)-, 6, 1-TMS 5, 1,3-bis(TMS) 8, and 1,1,3-tris(TMS) 9. Allylic lithiums with (CH(3)OCH(2)CH(2))(2)NCH(2)C(CH(3))(2)-, are 10, 1-TMS 11, and 1,3-bis(TMS), 12 compounds with -C(CH(3))(2)CH(2)N-((S)-(2-methoxymethyl)-pyrrolidino) at C(2) 13, 1-TMS 14, and 1,3-bis(TMS) 15. In the solid state, 8-10 and 12 are monomers, 6 and 13 are Li-bridged dimers, and 5 and 7 are polymers. In solution (NMR data), 5, 7-12, 14, and 15 are monmeric, and 6 is a dimer. All samples show lithium to be closest to one of the terminal allyl carbons in the crystal structures and to exhibit one-bond (13)C-(7)Li or (13)C(1)-(7)Li spin coupling, for the former typically ca. 3 Hz and for the latter 6-8 Hz. In every structure, the C(1)-C(2) allyl bond is longer than the C(2)-C(3) bond, and both lie between those for solvated delocalized and unsolvated localized allylic lithium compounds, respectively, as is also the case for the terminal allyl (13)C NMR shifts. Lithium lies 40-70 degrees off the axis perpendicular to the allyl plane at C(1). These effects are variable, so the trend is that the differences between the C(1)-C(2) and C(2)-C(3) bond lengths, (13)delta(3)-(13)delta(1) values, and the (13)C(1)-(7)Li or (13)C-(6)Li coupling constants all increase with decreasing values of the torsional angle that C(1)-Li makes with respect to the allyl plane.

Journal Article↗

PubMed1996

Lithium and Cesium Ion-Pair Acidities of Dibenzyl Ketone. Aggregation of Lithium and Cesium Ion Pairs of the Enolate Ion and Dianion(1)(,).

Spectral study of the cesium and lithium enolates of dibenzyl ketone (DBK) showed that both salts exist as contact ion pairs in THF solutions. The spectral data for the dicesium salt of DBK indicate that it exists as triple ions in which both cations are in contact with the dianion. The dilithium salt of DBK forms triple ions of two types in THF: in one, both cations are in contact with the DBK dianion, in the other, one of the lithium cations is solvent-separated. Evidence for dimerization of the ion pairs was obtained for both lithium and cesium enolates of DBK from UV-vis spectral (blue shift of the absorbance band at higher concentrations) and acidity (the decrease of pK at higher concentrations) studies. The dimerization constant for the cesium enolate of DBK obtained from the acidity data (3.5 x 10(3) M(-)(1)) is considered to be more accurate than that from the spectral analysis (1.7 x 10(3) M(-)(1)). The lithium enolate is much less dimerized than its cesium counterpart with a dimerization constant from acidity data of 4.2 x 10(2) M(-)(1). The first and second cesium pK values of DBK are 18.07 and 33.70, respectively, compared to the first lithium pK of 11.62.

Journal Article↗

PubMed1992

Synergistic induction of interleukin-6 by tumor necrosis factor and lithium chloride in mice: possible role in the triggering and exacerbation of psoriasis by lithium treatment.

One of the side effects of treatment of manic depressive disease with lithium salts is the triggering or aggravation of psoriasis. In a murine model, subcutaneous (s.c.) injection of a combination of tumor necrosis factor (TNF) and lithium chloride (LiCl) induces a psoriasiform inflammatory reaction. Recent studies suggest that interleukin (IL)-6 and its inducer TNF may play an important role in the pathophysiology of psoriasis. To understand the mechanism involved in the exacerbation of psoriasis by lithium salts, the IL-1, IL-6 and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels in murine skin injected with TNF in combination with LiCl were studied. IL-6 levels in skin extracts of mice treated s.c. with a combination of TNF and LiCl were considerably increased as compared to the levels found in skin extracts from mice treated with TNF or LiCl alone. In contrast, in the same skin extracts IL-1 levels were not changed and GM-CSF was even not detectable. Although less pronounced, increased IL-6 levels could also be found in the sera of mice treated s.c. with TNF and LiCl. Injection with IL-1, interferon-gamma, lipopolysaccharide, or phorbol 12-myristate 13-acetate also induced IL-6 in murine skin. However, these IL-6 levels were not enhanced by co-treatment with LiCl. Likewise, on inflammatory reaction could be seen in mice treated with these agents. These results suggest a role for endogenous TNF and IL-6 in the triggering or aggravation of psoriasis in lithium-treated patients.

Animals↗

PubMed1990

Effect of menstrual cycle phase and oral contraceptive use on serum lithium levels after a loading dose of lithium in normal women.

Serum lithium levels were analyzed in six healthy, normal women during the midfollicular, midluteal, and premenstrual phases of their menstrual cycles after they had received 300 mg of lithium carbonate orally. An identical protocol was followed for seven women with artificial cycles induced by oral contraceptive steroids. Analysis of variance for repeated measures over time showed no significant differences between groups or between cycle phases. Therefore, hormonal effects of ovarian or contraceptive steroids per se do not appear to alter serum lithium concentrations. Other factors may account for changing lithium requirements during the menstrual cycle in some patients with affective illness.

Contraceptives, Oral↗