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May 2, 2011

Lithium and Psychiatric Treatment

Lithium was introduced over sixty years ago, and it continues to be a valuable drug for the treatment of mood disorders, especially Bipolar disorder. Recent studies continue to substantiate the use of Lithium as a foundation for treatment of mood dysfunction. Because Lithium does not generate large revenues for the pharmaceutical industry, the focus has been placed on newer medications that are still under patent. Hirschkowitz and colleagues state in the Harvard Review of Psychiatry, “Lithium, valproate, benzodiazepines, and antipsychotics have been reported effective for mania-which was essentially the state of the field in 1970. Despite an FDA indication for the use of lamotrigine for depression and depression maintenance, the supporting evidence is conflicting. For bipolar maintenance, the evidence is overwhelming in support of lithium and very thin for valproate and carbamazepine. There is emerging evidence that several atypical antipsychotics may have efficacy in prevention (1).”

Lithium has also proven its role as an anti-suicidal agent in patients with depression. Interesting new research is showing a neuro-protective effect of Lithium preventing dementia and neurodegenerative disorders such as Huntington’s Chorea and amyotrophic lateral sclerosis. A study in the British Journal of Psychiatry from 2007 evaluated patients with Bipolar Disorder, who normally have an increased risk of developing dementia. They found that lithium treatment prevented the development of Alzheimer’s disease, lowering the risk down to levels found in the general population (2). Another research study in the same journal found that lithium treatment could improve cognitive performance in patients with Alzheimer’s Disease (3).

In summary, Lithium remains a valuable tool in the treatment of mood disorders, and a new frontier has begun, utilizing Lithium to prevent or mediate cognitive dysfunction related to dementia, as well as to protect against neurodegenerative disorders.

1. Harv Rev Psychiatry. 2010 Oct;18(5):266-78.
The pharmacological treatment of bipolar disorder: the question of modern advances.
Hirschowitz J, Kolevzon A, Garakani A.

2. Br J Psychiatry. 2007 Apr;190:359-60.
Lithium and risk for Alzheimer’s disease in elderly patients with bipolar disorder.
Nunes PV, Forlenza OV, Gattaz WF.

3. Br J Psychiatry. 2011 May;198:351-6.
Disease-modifying properties of long-term lithium treatment for amnestic mild cognitive impairment: randomised controlled trial.
Forlenza OV, Diniz BS, Radanovic M, Santos FS, Talib LL, Gattaz WF.

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