LITHIUM IN PSYCHIATRY - A REVIEW

Lithium is used for the treatment of a number of psychiatric disorders . The effectiveness of the agent for treating mania and for the long t erm treatment of bipolar and major depressive disorders is well establ ished. It is also of value in bipolar depression, schizoaffective diso rder and aggression, and as an augmenting agent in treatment-resistant depression. Lithium has also been tried in numerous other psychiatric and nonpsychiatric conditions. The chemical characteristics of lithiu m mean that blood concentration monitoring is a simple and useful comp onent of the clinical use of this agent. Adverse effects to lithium ar e common, but usually tolerable during the course of therapy. Postural tremor sometimes requires treatment with beta-adrenoceptor blockers o r primidone. Both hypothyroidism and goitre are common complications t hat can usually be managed by supplemental thyroid hormone. Cardiovasc ular adverse effects are uncommon, but occasionally lithium-induced si nus node dysfunction limits treatment. Bodyweight gain can also occur and is difficult to treat. Adverse effects on the kidneys include poly uria and impaired concentrating ability, and, rarely, nephrotic syndro me and reduced glomerular filtration rate (GFR). Lithium intoxication is predominantly a neurotoxicity that is often reversible, but sometim es causes permanent neurological damage or results in death. Haemodial ysis is recommended for severe intoxication. Dietary and drug interact ions with lithium can be dangerous. Low sodium intake results in reduc ed renal lithium clearance. Elevated blood lithium concentration can b e caused by some diuretics, nonsteroidal anti-inflammatory drugs and a ngiotensin converting enzyme inhibitors. Despite some imperfections, l ithium remains the treatment of choice for bipolar disorder, and is of ten useful for several other psychiatric conditions.