Abstract We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes.
Extrapyramidal side effects — movement-related problems such as muscle rigidity, parkinsonismdystoniaetc. Euthyroid goitre — i. Hypothyroidism — a deficiency of thyroid hormone.
The lowest effective dose is used to limit the risk of side effects.
Hypothyroidism[ edit ] The rate of hypothyroidism is around six times higher in people who take lithium. Low thyroid hormone levels in turn increase the likelihood of developing depression. People taking lithium thus should routinely be assessed for hypothyroidism and treated with synthetic thyroxine if necessary.
Clearance of lithium by the kidneys is usually successful with certain diuretic medications, including amiloride and triamterene. Lithium is also believed to permanently affect renal function[ how?
Lamotrigine seems to be a possible alternative to lithium in pregnant women for the treatment of acute bipolar depression or for the management of bipolar patients with normal mood. Valproic acid and carbamazepine also tend to be associated with teratogenicity.
While it appears to be safe to use while breastfeeding a number of guidelines list it as a contraindication  including the British National Formulary. Chronic kidney disease is found in about one-third of people undergoing long-term lithium treatment, according to one study. Its levels are therefore sensitive to water and electrolyte balance.
This is likely due to constriction of the afferent arteriole of the glomerulus, resulting in decreased glomerular filtration rate and clearance.
Another possible mechanism is that ACE inhibitors can lead to a decrease in sodium and water.
This will increase lithium reabsorption and its concentrations in the body. These drugs include theophyllinecaffeineand acetazolamide. Additionally, increasing dietary sodium intake may also reduce lithium levels by prompting the kidneys to excrete more lithium.
Lithium toxicity Lithium toxicity, which is also called lithium overdose and lithium poisoning, is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactions in the body.
In acute toxicity, people have primarily gastrointestinal symptoms such as vomiting and diarrheawhich may result in volume depletion. During acute toxicity, lithium distributes later into the central nervous system causing dizziness resulting in mild neurological symptoms, such as dizziness.
During chronic toxicity, the gastrointestinal symptoms seen in acute toxicity are less prominent. The symptoms are often vague and nonspecific. If the toxicity is severe, lithium may need to be removed from the body. Mechanism of action[ edit ] The specific biochemical mechanism of lithium action in stabilizing mood is unknown.Lithium is used primarily for bipolar disorder.
It is sometimes used when other treatments are not effective in a number of other conditions, including major depression, schizophrenia, disorders of impulse control, and some psychiatric disorders in children.
In mood disorders, of which bipolar disorder is one, it decreases the risk of suicide. This benefit is not seen with other medications.
Review of the available RCT and RWE data presented in this paper permits an overview of the efficacy, effectiveness, and safety/tolerability of quetiapine versus lithium in different phases of bipolar I or II disorder.
Lithium information based on scientific evidence including how it works, safety concerns, scientific based what it is effective for and possible drug interactions. In this review we will consider lithium, the drug of choice in treatment of this disorder with special emphasis on pharmacology and toxicity.
We have also elucidated the alternatives to lithium, since it has a wide spectrum of side-effects. This article needs attention from an expert in Medicine. Please add a reason or a talk parameter to this template to explain the issue with the kaja-net.comoject Medicine may be .
Background Episodes of depression are the most frequent cause of disability among patients with bipolar disorder. The effectiveness and safety of standard antidepressant agents for depressive.