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At least 19 recordsLinked to original sources
PubMed1981

Estimation of lithium dose requirement by lithium clearance, serum lithium and saliva lithium following a loading dose of lithium carbonate.

Renal lithium clearance and the serum lithium levels following a single oral loading dose of lithium were used as measures to predict lithium dose requirement during long-term maintenance at 3 different psychiatric centers in North America. Saliva lithium values were also investigated at one of the centers. The correlation between lithium clearance and the 17-hour serum lithium level, and subsequent dosage was high; the mean correlation co-efficient from the 3 centers being 0.84 for renal lithium clearance and 0.75 for both the 17-hour and 10-hour serum lithium levels. These tests can therefore be recommended as a guide to estimate lithium dose requirement in patients starting lithium maintenance treatment although absolute reliance should not be placed on the prediction formulae obtained. The correlation between saliva lithium and eventual dosage was poor and of little predictive value.

Adult↗
PubMed1985

Diurnal variations in serum lithium and renal lithium clearance in rats given lithium as a single small dose or as multiple high doses.

Clearance determinations were carried out in three groups of rats: A high lithium group given food to which 70 mmol/kg of lithium were added for 4-6 weeks leading to a mean serum lithium concentration of 0.85 mmol/l, a low lithium group given food to which 15 mmol/kg of lithium were added for two days before the clearance period leading to a mean serum lithium concentration of 0.22 mmol/l, and a group given the same food without lithium. The sodium and potassium contents of the food were kept high in order to avoid lithium-induced development of negative sodium balance and excessive polyuria. The rats were housed in four rooms with 6-hour displaced 24-hour light-dark cycles. The results showed that high doses of lithium led to a significant increase of the lithium clearance and the urine flow. Small amounts of lithium influenced neither the clearance values nor the urine flow. All renal variables were increased by about 50-100% during the dark period. The serum lithium concentration was least influenced by the diurnal rhythm. It is concluded that serum lithium concentrations measured at any time of the day are fairly representative of the 24 hours. A lithium clearance measured during daytime is valid for this period only. Long-term lithium treatment leads to an increase of the renal lithium clearance but does not diminish the normal diurnal rhythm of the kidney function.

Animals↗
PubMed1987

Lithium distribution in mania: plasma and red blood cell lithium, clinical state, and monoamine metabolites during lithium treatment.

We examined red blood cell (RBC) and plasma lithium concentrations and RBC/plasma lithium ratios in 14 manic patients during lithium treatment as part of the National Institute of Mental Health's Collaborative Program on the Psychobiology of Depression, Biological Studies. All of the lithium measures increased during treatment, especially RBC lithium. There were positive correlations between the RBC lithium concentration and the RBC/plasma lithium ratio and their maximal values in a single-dose pharmacokinetic experiment before treatment. After 5 and 16 days of treatment, patients with good subsequent outcome had higher RBC/plasma lithium ratios than did patients with poor outcome. Early in treatment, there was a negative correlation between lithium concentrations and severity of mania. During treatment, there was a negative correlation between RBC lithium and urinary MHPG excretion. There was a positive correlation between RBC or plasma lithium during the first few days of treatment and subsequent reduction in norepinephrine excretion during treatment. At 3 weeks, there were negative correlations between reductions in catecholamine measures and lithium concentrations. These data suggest that there are changes in the sensitivity of behavior and catecholamine function to lithium during treatment. RBC concentrations of lithium appear to be a potentially useful indicator of its behavioral and neurochemical effects.

Adult↗
PubMed1984

Saliva lithium levels in children: their use in monitoring serum lithium levels and lithium side effects.

The reliability of saliva lithium levels in monitoring serum lithium levels in children taking lithium has rarely been studied, despite the potential usefulness of such a study and despite a number of adult studies focusing on the technique. In a study of 61 aggressive school-age children diagnosed as undersocialized, aggressive conduct disorder, a subsample of 21 children received lithium. Saliva lithium levels aided in monitoring side effects, and in 15 of the 21 children simultaneous saliva and serum lithium levels were done. These were highly correlated (r = 0.83) and the saliva to serum ratio was 2.53 across subjects. The results indicate that future work with larger numbers of children should study the ratio of saliva to serum lithium levels. Adult studies have shown that there is too great a variability in saliva to serum lithium level ratios to support the use of a fixed saliva to serum lithium ratio. This may not be the case in children. Seventeen children from the lithium subsample experienced 41 lithium-related side effects. Most children suffered side effects on relatively high doses of lithium, and those few who experienced side effects on low dosage had saliva lithium levels that were proportionately high. However, it remains unclear whether saliva lithium can be used to monitor side effects.

Child↗
PubMed1979

Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate.

A recent study by Kling et al (1978) noted the finding of higher lithium concentrations in serum and brain of rats after an intraperitoneal injection (2 mmol lithium kg-1) of lithium orotate as a slurry than of lithium carbonate in solution. The authors suggested that lithium orotate might offer advantages in the treatment of patients. We repeated the experiments of Kling et al but in addition examined the kidney function of the rats. Glomerular filtration rate and urine flow were markedly lower in rats given lithium orotate than in rats given lithium carbonate, sodium chloride or a sham injection. The renal lithium clearance was significantly lower, the kidney weight and the lithium concentrations in serum, kidney and heart significantly higher after injection of lithium orotate than after injection of lithium carbonate. The higher lithium concentrations could be accounted for by the lower kidney function. It seems inadvisable to use lithium orotate for the treatment of patients.

Animals↗
PubMed1979

The effect of water deprivation on lithium clearance and lithium excretion fraction in lithium-polyuric rats.

The effect of water deprivation on lithium clearance was studied in rats with lithium-induced polyuria. During a 3-hr period of water deprivation, the rats lost water in amounts corresponding to about 10% of body weight. Lithium clearance fell to about 25% of the level observed in rats which were not water deprived. During shorter periods of water deprivation, the fall of lithium clearance was less. The decrease of lithium clearance was partly due to a fall of inulin clearance and partly due to a fall of fractional excretion of lithium. The decrease of the two variables contributed to the same extent to the decrease of lithium clearance. The findings support the suggestion that insufficient intake of water in patients with lithium-induced polyuria may lead to a rapid lowering of lithium clearance and, hence, to a rise of the serum lithium concentration and development of intoxication.

Animals↗
PubMed1983

Parkinsonian symptoms with lithium, lithium-neuroleptic, and lithium-antidepressant treatment.

Eighty-one patients treated for a least 3 months with lithium were examined for the presence of parkinsonian symptoms. Twenty-four patients were receiving treatment with lithium alone, 30 with lithium and 1 or more neuroleptics, and 27 with lithium and antidepressant. Twenty-four of the patients were found to be free from parkinsonian symptoms. Severe rigidity was not found. Two patients receiving neuroleptic with lithium and 6 on lithium-antidepressant combinations exhibited severe tremor. Neuroleptics administered concomitantly with lithium did not aggravate parkinsonian symptoms. The combination of lithium and an antidepressant significantly increased tremor in comparison to lithium alone.

Adult↗
PubMed1996

Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium-withdrawal study.

BACKGROUND: Controversy remains over the magnitude and reversibility of reduced renal function in long-term lithium patients. METHODS: Thirteen patients with 18 years (range 15-24) on lithium discontinued the treatment, and were re-examined twice after 5 and 9 weeks (4-16) off lithium. They were compared to a non-lithium psychiatric control group, matched for age and sex. RESULTS: Glomerular filtration rate (GFR) tended to improve from 69 (39-96) to 74 (39-94) ml/min/1.73 m2 BSA, P = 0.057, which was not significantly different from 78 (61-106 ml/min per 1.73 m2 BSA in the controls. Reduced GFR was found in only two of the lithium patients off lithium, and in none of the controls. Maximal urinary concentrating capacity did not improve at all. It was 637 (130-875) mOsm/kg H2O in the lithium patients, which was lower than 856 (705-1.035) mOsm/kg H2O (P < 0.01) in the controls. Two of the lithium patients had isosthenuria. CONCLUSIONS: Lithium patients often have an irreversible, clinically important reduction of Umax, sometimes progressing to nephrogenic diabetes insipidus, while GFR is well preserved in most patients.

Adult↗
PubMed1999

Structure determination of lithium chloroacetate, lithium bromoacetate and lithium iodoacetate by powder diffraction.

Most halogenoacetates of alkali salts readily undergo a thermally induced polymerization reaction to poly-(hydroxyacetic acid) in the solid state. The lithium salts represent a remarkable exception. The crystal structures of lithium chloroacetate, lithium bromoacetate and lithium iodoacetate were determined ab initio from synchrotron powder diffraction data. The three compounds are isostructural and differ considerably from the structures of sodium chloroacetate and silver chloroacetate, two compounds that undergo polymerization. Most likely, the strong polarizing effect of the small lithium cation is responsible for the unfavorable crystal structure in which each lithium cation is coordinated to four O atoms from four different halogenoacetate molecules. Lithium chloroacetate: a = 9.3882 (9), b = 4.8452 (4), c = 9.0119 (7) Å, beta = 94.330 (5) degrees; lithium bromoacetate: a = 9.7165 (11), b = 4.8610 (6), c = 9.0228 (11) Å, beta = 93.946 (5) degrees; lithium iodoacetate: a = 10.1812 (10), b = 4.8922 (8), c = 9.0468 (10) Å, beta = 93.251 (5) degrees, all crystallizing in space group P2(1)/c with Z = 4.

Journal Article↗
PubMed1992

Bioavailability of lithium from lithium citrate syrup versus conventional lithium carbonate tablets.

The bioavailability of lithium citrate syrup was compared with that of regular lithium carbonate tablets in 18 healthy male human volunteers. Blood samples were collected up to 48 h after dosing. Lithium serum concentrations were determined by means of AAS. The absorption rate following oral administration of the syrup was greater (tmax 0.8 h) than following administration of regular tablets (tmax 1.4 h). Maximum lithium serum concentrations, however, were only about 10 per cent higher after syrup dosing and serum concentrations resulting from syrup and tablets were almost superimposable from 2 h after dosing. The terminal half-life of lithium was found to be 22 h after syrup as well as after tablet dosing. No side-effects were observed during the study. The bioavailability of lithium from syrup relative to tablets was found to be bioequivalent with respect to the maximum lithium serum concentration and the extent of drug absorption (AUC).

Administration, Oral↗
PubMed1990

Subclinical lithium neurotoxicity: correlation of neural conduction abnormalities and serum lithium level in manic-depressive patients with lithium treatment.

Nerve conduction velocities (NCVs) and multimodality evoked potentials were studies in 28 manic-depressive patients under lithium prophylaxis with serum lithium levels between 0.320 and 0.980 mEq/L. Slowing of motor and sensory NCVs and prolonged central neural conduction times obtained from somatosensory and brainstem auditory evoked potentials were found to correlate with serum lithium levels. Lithium-induced changes in cell membrane conductivity and in the synaptic transmission are considered responsible for the neurotoxic effects of lithium.

Adult↗
PubMed1977

Comparison of plasma lithium levels and their interindividual variations with coated lithium carbonate tablets and a medium-slow-release lithium sulphate preparation (Lithionit Duretter).

In a cross-over study in 10 subjects, rapidly dissolving coated lithium carbonate tablets and medium-slow-release lithium sulphate tablets were compared. Both preparations were administered twice a day. They gave similar post-absorptive concentrations of lithium in plasma and similar standard deviations of these concentrations. The medium-slow-release tablets gave smaller increases of lithium in plasma, and postponed the absorption peaks. They also gave less interindividual variation of lithium in plasma during the first few hours after administration.

Adult↗
PubMed1990

Lithium uptake rate and lithium: lithium exchange rate in human erythrocytes at a nearly pharmacologically normal level monitored by 7Li NMR.

7Li NMR was used to follow the rate of uptake of Li+ and Li+:Li+ exchange rates in human erythrocytes at an external lithium concentration of 2 mM, marginally higher than used in therapeutic applications of lithium. The rate of Li+:Li+ exchange is approximately 16 times faster than the rate of Li uptake from the medium. The results are in agreement with lithium-sodium countertransport being the dominant mode for lithium uptake into erythrocytes and for the countertransport system having a greater affinity for Li+ than for Na+.

Biological Transport↗
PubMed1996

Lithium side effects in relation to brain lithium concentration measured by lithium-7 magnetic resonance spectroscopy.

1. The relationship between lithium (Li) side effects and brain Li concentration was examined in 17 patients with bipolar disorder treated with Li and other psychotropic drugs. 2. Brain Li concentration was measured by Li-7 magnetic resonance spectroscopy (MRS). Side effects were assessed using the UCLA General Side Effect Rating Scale For Lithium Treatment (GSE). 3. There was no correlation between the total GSE score and the brain, serum, or erythrocyte Li concentrations. Patients with hand tremor had significantly higher brain Li level (0.51 + or - 0.27 mM) than those without apparent tremor (0.36 + or - 0.20 mM), but no significant difference in serum Li level was seen. As far as the patients had hand tremor, they rarely had brain Li concentration less than the therapeutic range (1 of 15 measurement). On the other hand, they often had brain Li levels less than the therapeutic range when they did not have apparent tremor (13 of 52 measurements). 4. This preliminary study suggests that hand tremor is associated with the brain Li concentration.

Adult↗
PubMed1996

Two derivatives of lithium isodicyclopentadienide: [(1,2,3,3a,7a-eta)-4,5,6,7-tetrahydro-4,7-methanoindenido] (N,N,N1,N1-tetramethylethylenediamine)lithium and Bis (1,4,7,10-tetraoxacyclododecane)-lithium(1+) Bis[(1,2,3,3a,7a-eta)-4,5,6,7-tetrahydro-4,7-methanoindenido]lithate(1- ).

Selective crystallization of a solution of lithium isodicyclopentadienide, (isodiCp)Li, in dry thf or diethyl ether under argon has produced two lithium complexes: (isodiCp)Li(TMEDA), [Li(C10H11)(C6H16N2)], (4), and [Li(12-crown-4)2]+. [Li(isodiCp)2]-, [Li(C8H16O4)2]-[Li(C10H11)2], (5). In (4) the Li+ ion is coordinated to the two N atoms of the disordered TMEDA and is eta 5-coordinated to the Cp ring of the isodiCp ligand. The Li-(Cp ring centroid) distance is 1.906 (7) A. In (5) there are two independent half-molecules of the anion and one molecule of the cation in the asymmetric unit. In each anion, the Li+ ion occupies a crystallographic inversion center and is eta 5-coordinated to the two Cp rings of two isodiCp ligands. The Cp rings are in a staggered arrangement, as required by the inversion center. The Li-(Cp ring centroid) distances for the two anions are 1.987 (3) and 2.008 (3) A. In the cation of (5), the Li+ ion is coordinated to two 12-crown-4 ligands, one of which is disordered. Both (4) and (5) exhibit exo coordination of the Li+ ion to the isodiCp ligand, with a resultant slight endo bending of this ligand.

Crystallization↗
PubMed2001

Lithium for maintenance treatment of mood disorders.

BACKGROUND: Mood disorders are common, disabling and tend to be recurrent. They carry a high risk of suicide. Maintenance treatment, aimed at the prevention of relapse, is therefore of vital importance. Lithium has been used for some years as the mainstay of maintenance treatment in bipolar affective disorder, and to a lesser extent in unipolar disorder. However, the efficacy and effectiveness of prophylactic lithium therapy has been disputed. Low suicide rates in lithium-treated patients have led to claims that lithium has a specific anti-suicidal effect. If so, this is of considerable importance as treatments for mental disorders in general have not been shown convincingly to be effective in suicide prevention. OBJECTIVES: 1. To investigate the efficacy of lithium treatment in the prevention of relapse in recurrent mood disorders. 2. To examine the effect of lithium treatment on consumers' general health and social functioning, its acceptability to consumers, and the side-effects of treatment. 3. To investigate the hypothesis that lithium has a specific effect in reducing the incidence of suicide and deliberate self-harm in persons with mood disorders. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) and The Cochrane Controlled Clinical Trials Register (CCTR) were searched. Reference lists of relevant papers and major text books of mood disorder were examined. Authors, other experts in the field and pharmaceutical companies were contacted for knowledge of suitable trials, published or unpublished. Specialist journals concerning lithium were hand searched. SELECTION CRITERIA: Randomised controlled trials comparing lithium with placebo, where the stated intent of treatment was maintenance or prophylaxis. Participants were males and females of all ages with diagnoses of mood disorder. Discontinuation studies (in which all participants had been stable on lithium for some time before being randomised to either continued lithium treatment or placebo substitution) were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted from the original reports independently by two reviewers. The main outcomes studied were related to the objectives stated above. Data were analysed for all diagnoses of mood disorder and for bipolar and unipolar disorder separately. Data were analysed using Review Manager version 4.0. MAIN RESULTS: Nine studies were included in the review, reporting on 825 participants randomly allocated to lithium or placebo. Lithium was found to be more effective than placebo in preventing relapse in mood disorder overall, and in bipolar disorder. The most consistent effect was found in bipolar disorder (random effects OR 0.29; 95% CI 0.09 to 0.93 ). In unipolar disorder, the direction of effect was in favour of lithium, but the result (when heterogeneity between studies was allowed for) did not reach statistical significance. Considerable heterogeneity was found between studies in all groups of patients. The direction of effect was the same in all studies; no study found a negative effect for lithium. Heterogeneity may have been due to differences in selection of participants, and to differing exposures to lithium in the pre-study phase resulting in variable influence of a discontinuation effect. There was little reported data on overall health and social functioning of participants under the different treatment conditions, or on the participants' own views of their treatment. Descriptive analysis showed that assessments of general health and social functioning generally favoured lithium. Small absolute numbers of deaths and suicides, and the absence of data on non-fatal suicidal behaviours, made it impossible to draw meaningful conclusions about the place of lithium therapy in suicide prevention. REVIEWER'S CONCLUSIONS: This systematic review indicates that lithium is an efficacious maintenance treatment for bipolar disorder. In unipolar disorder the evidence of efficacy is less robust. This review does not cover the relative efficacy of lithium compared with other maintenance treatments, which is at present unclear. There is no definitive evidence from this review as to whether or not lithium has an anti-suicidal effect. Systematic reviews and large scale randomised studies comparing lithium with other maintenance treatments (e.g. anti-convulsants, antidepressants) are necessary. Outcomes relating to death and suicidal behaviour should be included in all future maintenance studies of mood disorder.

Antimanic Agents↗