From the Guidelines
The primary endpoints for psychiatric use of lithium include reduction in manic symptoms, stabilization of mood, prevention of recurrent mood episodes, and reduction in suicidal behavior, with therapeutic blood levels typically maintained between 0.6-1.2 mEq/L 1. When treating acute mania, clinicians look for decreased hyperactivity, improved sleep, reduced grandiosity, and normalization of speech patterns, typically within 1-2 weeks of reaching therapeutic levels. For maintenance therapy in bipolar disorder, the endpoint is prevention of both manic and depressive episodes, with success measured by longer periods between episodes and reduced episode severity. Some key points to consider when using lithium include:
- Lithium's anti-suicidal properties are evidenced by decreased suicidal ideation, attempts, and completions 1.
- Regular monitoring of serum lithium levels is essential, with more frequent checks during initiation and dose adjustments, and then typically every 3-6 months during stable maintenance.
- Lithium's effectiveness is believed to result from its modulation of neurotransmitter systems, stabilization of neuronal membranes, and neuroprotective effects that help regulate mood and reduce impulsivity.
- Maintenance therapy is often needed for youths with bipolar disorder, with some individuals needing lifelong therapy when the benefits of continued treatment outweigh the risks 1. It is also important to note that any attempts to discontinue prophylactic therapy should be done gradually, while closely monitoring the patient for relapse 1.
From the FDA Drug Label
Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of those episodes which may occur. The endpoints for psychiatric use of lithium are:
- Normalization of symptomatology within 1 to 3 weeks in patients experiencing a manic episode
- Reduction of the frequency of manic episodes
- Diminishment of the intensity of manic episodes 2
From the Research
Endpoints for Psychiatric Use of Lithium
The endpoints for the psychiatric use of lithium include:
- Maintenance treatment of bipolar disorder, with a recommended plasma concentration of 0.6-0.8mmol/L 3
- Treatment of mania, with lithium considered a first-line intervention 3
- Management of acute bipolar depression, although support for this use is relatively modest 3
- Reduction of the risk of suicide, with lithium having a tangible effect in this area 3, 4, 5, 6
- Augmentation of antidepressants in treatment-resistant depression, considered one of the best strategies in this context 4, 5
- Prophylaxis of unipolar depression, with lithium established as an alternative to prophylaxis with an antidepressant 4, 7, 6
- Treatment of acute manic and depressive episodes, with some demonstration of lithium's efficacy in these areas 7
- Use in pregnancy and the postpartum period, with guidelines available for the application of lithium in these contexts 7
- Prevention of dementia, with some promising effects of lithium observed in neurodegenerative disorders 5, 6
Special Considerations
When using lithium, special consideration should be given to:
- Ideal plasma concentration, with 0.6-0.8mmol/L considered optimal for maintenance treatment 3
- Regular monitoring of renal and endocrine function, to minimize the risk of side effects 3
- Dosing in special populations, such as younger adults and the elderly, with lower doses and plasma levels potentially more suitable in these groups 3
- Management of side effects, with strategies available to minimize nuisance side effects and medically serious side-effects 6