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Bipolar Disorder :
Bipolar Disorder :
Bipolar disorder is a serious mental illness that causes unusual shifts in mood, ranging from extreme highs (mania or “manic” episodes) to lows (depression or “depressive” episode).
A person who has bipolar disorder also experiences changes in their energy, thinking, behavior, and sleep. During bipolar mood episodes, it is difficult to carry out day-to-day tasks, go to work or school, and maintain relationships.
Historical story :
Historical story :
The use of lithium in psychiatry goes back to the mid-19th century. Early work, however, was soon forgotten, and John Cade is credited with reintroducing lithium to psychiatry for mania in 1949. Mogens Schou undertook a randomly controlled trial for mania in 1954, and in the course of that study became curious about lithium as a prophylactic for depressive illness. In 1970, the United States became the 50th country to admit lithium to the marketplace. Meanwhile, interest in lithium for the prophylaxis of depression was growing apace and today the agent is widely prescribed for that indication, even though it has not been accepted by the Food and Drug Administration. Lithium was almost derailed by a small group of opponents from the Maudsley Hospital and its status today is threatened by the "mood stabilizers."
Mechanism of Action :
Mechanism of Action :
Lithium's precise mechanism of action is still under investigation and not fully comprehended yet.
Lithium induces changes in sodium transport within nerve and muscle cells, and it also influences the metabolism of neurotransmitters, particularly catecholamines and serotonin.
Lithium may alter intracellular signaling via second messenger systems by inhibiting inositol monophosphate. This inhibitory action subsequently impacts neurotransmission mediated by the phosphatidylinositol secondary messenger system. Furthermore, lithium diminishes the activity of protein kinase C, leading to modifications in genomic expression associated with neurotransmission.
Lithium seems to elevate cytoprotective proteins, potentially triggering neurogenesis and increasing the gray matter volume.
Side Effects :
Side Effects :
Lithium can cause various side effects, often correlated with the dosage. The notable side effects of lithium include:
Cardiac: Bradycardia, flattened or inverted T waves, heart block, and sick sinus syndrome.
Central nervous system: Confusion, memory problems, new or worsening tremors, hyperreflexia, clonus, slurred speech, ataxia, stupor, delirium, coma, and infrequent seizures. These effects are thought to arise from potential overstimulation of the same sites responsible for therapeutic responses.
Renal: Nephrogenic diabetes insipidus characterized by polyuria and polydipsia. These adverse effects stem from the impact of lithium on ion transport mechanisms.
Hematologic: Leukocytosis and aplastic anemia.
Gastroenterology: Diarrhea and nausea.
Endocrinal: Euthyroid goiter or hypothyroid goiter.
Additional adverse effects include acne, rash, and weight gain. Lithium-induced weight gain is more frequently observed in women than men.
Toxicity :
Toxicity :
If lithium levels get too high, it can result in toxicity. Lithium toxicity also sometimes referred to as lithium poisoning, can appear in one of three forms:
Acute lithium toxicity: This type of toxicity results from taking too much lithium on one occasion.
Chronic lithium toxicity: This type is generally unintentional, resulting from taking in more lithium than the body can eliminate over time.
Acute-on-chronic lithium toxicity: Toxicity can also occur if you typically take your lithium as prescribed, but take too much on a particular day.
Mild cases of lithium toxicity can result in symptoms such as weakness, tremors, poor concentration, and diarrhea. In severe cases, it can lead to vomiting, more noticeable tremors, slurred speech, lethargy, and confusion.
While lithium toxicity is generally not fatal, it does require treatment. It may also require an extended hospital stay due to mobility and cognitive complications.
Drug-Food interaction :
Drug-Food interaction :
Avoid alcohol: Alcohol increased peak serum concentrations of lithium.
Avoid iodine-containing foods and supplements: Iodine and lithium may synergistically produce hypothyroidism.
Limit caffeine intake: Caffeine may decrease lithium concentrations.
Take with food: Food reduces gastrointestinal upset.
Drug-Drug interaction :
Drug-Drug interaction :
NSAID’s
Antibiotics
Diuretics
Blood pressure medications
Metronidazole.
Examples :
Examples :
Monograph :
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