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Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Many experts recommend continuing lithium during pregnancy in women with severe symptoms who have had a good response to lithium [136, 138]. Many “lithium responders” have a uniquely positive response to this medication; other mood stabilizers are not interchangeable. However, given the small risk of Ebstein's anomaly, some patients with less frequent, less severe episodes may be able to discontinue lithium during pregnancy or at least during the first trimester. When the decision is made to discontinue lithium, the drug should be tapered slowly (over the course of >15 days) as rapid discontinuation of lithium is associated with higher frequency of and reduced latency to recurrence of symptoms [139]. Prenatal screening, including high-resolution ultrasound and fetal echocardiography, should be conducted in pregnant women with first-trimester lithium exposure [136, 138].
Prescribing for a first episode of affective psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Lithium may be used by itself where there is reason to avoid antipsychotics (for example where the patient or family objects or there are severe sideeffects). Lithium works best in patients with pure, relatively mild mania.215 Many first-episode cases of mania fall into this category, and it is in those patients in whom the use of lithium alone may be most valuable.
Antimanic Drugs
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Contradictorily, lithium bears some properties of serotonin producing unpredictable effects on norepinephrine. The lithium produces antimanic effects by decreasing norepinephrine and dopamine turnover. Lithium blocks the progression of dopamine receptor super sensitivity similar to that of chronic antipsychotic therapy (Katzung et al., 2009). Lithium (concentrations of 1–10 mEq per liter) exhibits antagonistic effects on the liberation of norepinephrine (NE) and dopamine excluding serotonin from nerve terminals. Lithium momentarily enhances the discharge of serotonin from limbic system (Baldessarini et al., 1988). Lithium promotes the choline uptake into nerve terminals causing elevated synthesis of acetylcholine (Katzung et al., 2009).
Updated perspectives on how and when lithium should be used in the treatment of mood disorders
Published in Expert Review of Neurotherapeutics, 2023
Janusz K. Rybakowski, Ewa Ferensztajn-Rochowiak
The most common early side effects of lithium include gastrointestinal disturbances, polyuria, and tremor. Nausea and diarrhea occur in about 10–20% of lithium-treated patients and usually decrease during long-term therapy. They may be related to serum lithium concentration and the type of preparation (regular or sustained release). Polyuria and polydipsia can be alleviated after reducing the lithium dose. If the effect of lithium is favorable, severe polyuria can be treated with amiloride. If polyuria reaches the intensity of diabetes insipidus, lithium discontinuation is recommended. Tremor appears in about 1/5 of patients, usually in the first weeks of lithium treatment. The tremor is fine, similar to an essential tremor, and most apparent when taking planned actions such as lifting the cup or other precise hand movements. The recommended action is reduction of the lithium dose. If such treatment is not efficient, the administration of propranolol at doses of 20–80 mg/day is a potentially effective strategy [60].
Why lithium should be used in patients with bipolar disorder? A scoping review and an expert opinion paper
Published in Expert Review of Neurotherapeutics, 2022
Gaia Sampogna, Delfina Janiri, Umberto Albert, Filippo Caraci, Giovanni Martinotti, Gianluca Serafini, Alfonso Tortorella, Alessandro Zuddas, Gabriele Sani, Andrea Fiorillo
Lithium is used in different groups of patients with bipolar disorders, including adolescents, elderly people, patients with substance use disorders, and pregnant women. However, the use of lithium in these different populations should be adapted according to different socio-demographic and clinical characteristics, since the profile of efficacy, tolerability, and side-effects may be very different from one group to another. In fact, elderly people usually require lowdoses of lithium to achieve effective serum concentrations, due to pharmacokinetic modifications and to the reduced renal excretion. On the other hand, an increase of renal lithium excretion has been observed in pregnant women, which may require increased lithium doses to obtain the same effect; of course, the risk of toxicity of high doses of lithium should be balanced with the positive effects of increasing lithium dosage. These examples highlight the need for careful physical and laboratoristic examination of patients taking lithium, which cannot be restricted to the assessement of lithium serum levels.
Current advances in the management of cluster headaches
Published in Expert Opinion on Pharmacotherapy, 2021
Theodoros Mavridis, Marianthi Breza, Christina Deligianni, Dimos D. Mitsikostas
Lithium carbonate has limited evidence of effectiveness (LOA C) [29] for the preventive treatment of CH. Good response rates are shown in two studies [48,49] with the use of lithium but due to the narrow therapeutic window and its worse tolerability is recommended only for patients with chronic CH and when other drugs have failed [27,28]. Lithium, commonly administered in patients with affective disorders in order to reduce the risk of suicide and suicide attempts, could also benefit patients with CH, taking into consideration that CH has a high suicidality rate [50,51]. The initial dose is 300 mg daily and is titrated with close monitoring of lithium levels up to 600–1600 mg daily (2 to 4 divided doses). Lithium has many side effects, such as hyperthyroidism, cardiac arrhythmias, renal dysfunction, and tremor.