Lithium is considered the gold-standard treatment option for management of bipolar disorder. It is FDA approved for manic episodes and management of manic-depressive illness in children and adults, but lithium is often under-utilized. This is due to the development of newer mood stabilizers with seemingly fewer side effects. Lithium can tend to have a bad rap due to potential side effects but it offers many benefits that should cause prescribers and patients to reconsider its therapeutic use.
Reduced Risk of Suicide
Long-term lithium treatment offers multiple benefits that may not be widely known. The first and most recognized benefit is its propensity to protect against suicide. Suicidal ideation is most prevalent with individuals diagnosed with unipolar and bipolar depression. Numerous studies have proven that lithium is an effective treatment for reducing the risk of suicide for individuals with mood disorders. Committing suicide was found to be 5 times lower in patients treated with lithium than with other medications.
Anti-Inflammatory Effects
Lithium is credited for its anti-inflammatory and immune system improving properties. Leukocytes (white blood cells) help the body fight infections. Lithium increases the number of leukocytes in addition to preventing drug-induced leukopenia (reduced white blood cell count) often found with treatment from clozapine and carbamazepine. One study revealed decreased inflammatory antibodies and growth factors in people with bipolar disorder receiving lithium treatment.
Anti-Viral Effects
Lithium inhibits the replication of herpes simplex virus (HSV) and reduces the recurrence of genital herpes. There is also proof of anti-viral effects with ribonucleic acid (RNA) viruses. One study concluded a reduced occurrence of flu-like infections with individuals being treated with lithium compared to those being treated with anti-depressants. And another study revealed a decrease of respiratory infections in bipolar patients during lithium treatment compared with an increase in patients receiving valproate.
Lithium also appears to have anti-viral effects against COVID. After the start of the COVID-19 pandemic one study observed a relationship of the presence of COVID-19 infection and lithium serum levels. It found that patients with serum lithium levels within a therapeutic limit had significantly lower infection rates than those patients with subtherapeutic levels. Another study showed that patients infected with COVID-19 who were also receiving lithium treatment had a reduced number of hospital days.
Neuroprotective Effects
There is also a growing body of evidence that lithium has neuroprotective properties. It has been discovered that lithium treatment is associated with increased cerebral grey matter. Lithium treatment is also linked with a reduced risk of dementia and has possible therapeutic effects against Alzheimer’s disease and mild cognitive impairment. Studies have identified that people with bipolar disorder have an increased risk of dementia, but lithium treatment was associated with decreasing that risk.
Written By: Aimee Meehan, APRN, PMHNP-BC, CARN-AP
Sources:
Amsterdam, J. D., Garcı́a-España, F., & Rybakowski, J. (1998). Rates of flu-like infection in patients with affective illness. Journal of affective disorders, 47(1-3), 177-182.
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346.
De Picker, L. J., Leboyer, M., Geddes, J. R., Morrens, M., Harrison, P. J., & Taquet, M. (2022). Association between serum lithium level and incidence of COVID-19 infection. The British Journal of Psychiatry, 221(1), 425-427.
Donix M, Bauer M. Population studies of association between lithium and risk of neurodegenerative disorders. Curr Alzheimer Res. 2016; 13: 873-878
Ferensztajn-Rochowiak, E., Kaczmarek, M., Wójcicka, M., Kaufman-Szukalska, E., Dziuda, S., Remlinger-Molenda, A., ... & Rybakowski, J. K. (2018). Glutamate-related antibodies and peripheral insulin-like growth factor in bipolar disorder and lithium prophylaxis. Neuropsychobiology, 77(1), 49-56.
Hajek, T., & W Weiner, M. (2016). Neuroprotective effects of lithium in human brain? Food for thought. Current Alzheimer Research, 13(8), 862-872.
Rybakowski, J. K. (2020). Lithium – past, present, future. International Journal of Psychiatry in Clinical Practice, 24(4), 330–340. https://doi.org/10.1080/13651501.2020.1775855
Rybakowski, J. K., & Amsterdam, J. D. (1991). Lithium prophylaxis and recurrent labial herpes infections. Lithium, 2, 43-47.
Skinner, G. R. B., Hartley, C. E., Buchan, A., Harper, L., & Gallimore, P. (1980). The effect of lithium chloride on the replication of herpes simplex virus. Medical microbiology and immunology, 168, 139-148.
Spuch, C., López-García, M., Rivera-Baltanás, T., Cabrera-Alvargonzález, J. J., Gadh, S., Rodrigues-Amorim, D., ... & Olivares, J. M. (2022). Efficacy and safety of lithium treatment in SARS-CoV-2 infected patients. Frontiers in Pharmacology, 13, 850583.
Stahl, S. M., Grady, M. M., & Muntner, N. (2021). Stahl’s essential psychopharmacology : prescriber’s guide. Antipsychotics. Cambridge University Press.
Velosa, J., Delgado, A., Finger, E., Berk, M., Kapczinski, F., & de Azevedo Cardoso, T. (2020). Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta‐analyses. Acta Psychiatric Scandinavica, 141(6), 510-521. Assessed and Endorsed by the MedReport Medical Review Board
Comentários