The relative prophylactic efficacy of lithium against manic and depressive recurrences in bipolar patients.
ABSTRACT The relative prophylactic efficacy of lithium against manic and depressive recurrences was examined in 61 patients (22 males, 39 females) with bipolar manic-depressive disorders by comparing the number of manic and depressive episodes for each patient during equally long periods before and during lithium treatment. In all the patients, the percentage of depressive episodes during lithium was smaller than that of manic episodes. The better antidepressive than antimanic prophylactic effect of lithium was significant only in male patients, while the reduction of manic episodes during lithium was greater in females. The fraction of patients without depressive episodes on lithium was greater in the male group. The results obtained with this study design indicate that lithium is an effective antidepressive prophylactic agent in bipolar patients. Sex differences are also implicated in response to lithium prophylaxis.
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ABSTRACT: Previous investigations have elucidated an erythrocyte lithium-sodium countertransport (LSC) system as the primary mechanism for extruding lithium from the cell, and this activity has been described in terms of Michaelis-Menten kinetics. In most clinical studies the maximum velocity (Vmax) of the LSC has been measured by estimating the rate of lithium efflux from lithium-loaded cells. To date, few studies have examined whether the affinity (Km) of the LSC for lithium might be altered in patients with affective disorders. In the present study we examined LSC kinetic parameters (Vmax, leak, Km, and in vitro lithium ratio) at baseline in 80 patients with affective disorder and 25 healthy control subjects, and after 6 weeks of lithium administration in 33 of the patients. No differences in Vmax were observed between any patient and control group, although Vmax was significantly lower in unipolar depressed men compared to bipolar men (P = 0.043). The affinity (Km) of the transport 'carrier' for lithium did not differentiate between patient and control groups. Chronic lithium administration caused a decreased Vmax in bipolar men (P = 0.015), an increase in the in vitro lithium ratio in bipolar men (P = 0.002) and bipolar women (P = 0.002), and a marginal increase in Km in bipolar men (P = 0.08) and bipolar women (P = 0.06). Although the present data do not demonstrate an underlying difference for Km between affectively ill patients and controls, they do indicate a decrease in the affinity of the transport 'carrier' for lithium after chronic lithium administration.Journal of Affective Disorders 01/1988; 14(1):75-81. DOI:10.1016/0165-0327(88)90074-2 · 3.71 Impact Factor
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ABSTRACT: The treatment of bipolar disorder has seen greater innovation in the past decade than at any other time since the introduction of lithium and the neuroleptics a half-century ago. The place of lithium in contemporary psychiatric therapeutics has become controversial, calling for the present overview of research findings pertaining to its use in treating patients with bipolar disorder. Lithium, by itself, typically is inadequate for rapid control of acute mania; antipsychotics, divalproex, or potent sedatives are commonly used, with or without lithium, for this purpose. The special usefulness of lithium lies in long-term prevention of recurrences of mania and bipolar depression and in reducing risk of suicidal behavior. Lithium also may be beneficial in recurrent unipolar depression and is an effective adjunct for treatment-resistant depression. Expectations that prolonged untreated bipolar illness, multiple episodes, rapid cycling, or retreatment following discontinuation might routinely lead to lithium nonresponsiveness, and the belief that lithium is too toxic for use during pregnancy, have not been borne out by research. Lithium retains a substantial share of prescriptions for bipolar disorder and is inexpensive. No other treatment has performed as well as lithium in as many aspects of long-term care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared.Harvard Review of Psychiatry 03/2002; 10(2):59-75. DOI:10.1080/713854273 · 2.49 Impact Factor
Article: The role of gender in mixed mania.[Show abstract] [Hide abstract]
ABSTRACT: This article reviews the literature regarding possible gender differences in adults with mixed mania. Studies examining gender differences in the prevalence of mixed mania, biological abnormalities, suicidality, long-term outcome, and treatment response were analyzed. Data from these studies suggest that mixed mania may occur more commonly in women than in men, especially when defined by narrow criteria. There were no significant differences between men and women with mixed mania in biological abnormalities, suicidality, outcome, and treatment response.Comprehensive Psychiatry 03/2000; 41(2):83-7. DOI:10.1016/S0010-440X(00)90137-8 · 2.26 Impact Factor