EFFECTS OF LITHIUM CARBONATE ON ELECTROLYTE DISTRIBUTION IN MAN

Hypertension and diabetes in obesity: a review and new ideas on the contributing role of ions

Ion metabolism in obesity-associated hypertension is reviewed. A hypothesis is presented which proposes that ion imbalances in obesity may play an etiological role in obesity-associated diabetes mellitus as well. It is suggested that the rise in intracellular calcium--secondary to reduced sodium, potassium-activated adenosine triphosphatase (Na,K-ATPase) activity--may aid in the development of increased vascular tone and decreased glucose tolerance.

The Na,K-ATPase hypothesis for manic-depression. II. The mechanism of action of lithium

A model as to how lithium may work in the treatment and prevention of manic-depression is presented. Lithium accumulates intracellularly, and accumulates preferentially in more active neurons. Intracellular accumulation of lithium displaces intracellular sodium, which, in turn, decreases intracellular calcium. A decrease of intracellular calcium normalizes neuron activity in both mania and depression. This model is supported by the majority of clinical and experimental data.

Weight gain and body composition in lithium treated rats

Long-term lithium treated growing animals given 0.8-2.0 mmol/kg/day had a slightly but significantly faster weight gain than control animals. Greater doses did not give rise to significantly increased weight gain. Body composition, i.e., the percentage of water, fat, ash and "protein" was not affected in the faster growing lithium treated animals. The wet weight and the weight after drying of the stomach (with content) was increased shortly (hours) after the acute administration of lithium. The duration of the effect depended on the dose given. The weight of the large intestine was also increased after a dose of lithium, but only after some days of lithium pretreatment and mainly the wet weight. The effect was small but similar on the small intestine. In long-term lithium treated rats did the faecal weight and volume increase mainly due to increased water content, but only after some days of lithium treatment.

Lithium in adult anorexia nervosa. A pilot report on two patients

Two patients suffering from anorexia nervosa for many years who wished to gain weight were treated successfully with lithium carbonate. One patient gained 12 kg and the other 9 kg within 6 weeks. The weight-gain was maintained for a year of follow-up with lithium maintenance therapy.

The effects of administering lithium carbonate on the balance of Na, K and water in manic-depressive patients

Eleven patients in remission from manic-depressive illness were studied by means of metabolic balances before and after the administration of lithium carbonate. Lithium caused a sharp diuresis of isotonic saline and a smaller excretion of potassium over the course of two days. During the subsequent two days there occurred a compensatory retention of Na, K and water. These short-term changes were not associated with any significant alteration in the patients' mood. There was no significant and systematic retention of Na, K or water over the 14 days of Li administration. The recovery of Li was measured simultaneously. During the first week only a proportion of the administered Li was recovered in the urine and faeces, suggesting that a gradual distribution of Li throughout its body space was occurring. After the first week, nearly all the administered Li was recovered, indicating an equilibrium with an even distribution of the ion throughout its body space. This equilibrium was more complete at this early stage in those patients who had been given a smaller dose of lithium carbonate.

Plasma renin activity in depressed patients treated with increasing doses of lithium carbonate

Plasma renin activity (PRA) was measured in the supine position and after active upright stance in patients with endogenous depression and in a group of healthy volunteers serving as controls. In the depressed patients, PRA was further investigated in the same conditions during treatment with increasing doses of lithium carbonate. Basal PRA values were lower in depressed patients than in normal controls, particularly in the upright stance, and tended to rise gradually during lithium therapy. These findings suggest that lithium may work as a stimulant of the renin-angiotensin system, and possibly as an antidepressant, by way of producing functional activation of the norepinephrine system independent of its action on the water and electrolyte balance.

Effect of lithinum administration on RNA metabolism in rat brain

An attempt has been made to explain the changes in uric acid levels observed in the phase of manic depressive illness by suggesting that they may be a reflection of changes in brain RNA metabolism. The effect of prolonged lithium administration on RNA synthesis in rat brain and liver has been studied. Differences in the rate of turnover of brain RNA between the lithium-treated and saline control animals have been observed.

Lithium carbonate

The pertinent literature on lithium has been reviewed. It appears that in recent years there is renewed interest in the drug, its general and specific usage, its toxic effects and its research. It seems to have been generally accepted as specifically effective in the treatment of acute manic psychosis, and also it is believed to be useful as a prophylactic agent in selected cases of recurrent affective disorders.

Salivary excretion of lithium. I. Human parotid and submaxillary secretions

The concentration of lithium after oral administration in human parotid saliva, submaxillary saliva, and serum was determined; salivary concentrations were several times that of serum. Lithium in unstimulated saliva was directly proportional to serum concentration; lithium in stimulated parotid saliva tended to be a negative function of flow rate.

Metabolic balance studies on the effect of lithium salts in manic-depressive psychosis

The specific therapeutic effect of lithium salts in the treatment of the manic phases of manicdepressive psychosis was first reported by Cade (1949) and has been confirmed in a number of studies since (Schou, Juel-Nielson, Strömgren and Voldby, 1954; Maggs, 1963; Hartigan, 1963). In view of the claims made by Baastrup (1964) and more recendy by Baastrup and Schou (1967) that lithium also has a prophylactic action against both manic and depressive phases of manic-depressive psychosis it is likely that lithium salts will be used increasingly by psychiatrists.

The biochemistry of affective disorders

The title of this review would be regarded by some psychiatrists as provocative; they would relegate the biochemical concomitants of depression and mania to a secondary position and deny that biochemical changes have any place in the aetiology of these conditions. However, in my view, the weight of evidence, although it is by no means conclusive, suggests that biochemical changes are most important in the aetiology of affective disorders. A biochemical aetiology implies that there are certain biochemical changes in the brain which need to be restored to normal before the patient's clinical condition will improve. This does not deny that psychological and environmental events may precipitate and maintain the biochemical events which in turn lead to the affective disorder. The study of these biochemical events is clearly at too early a stage for speculations about the interrelationship between environmental and endogenous elements to be fruitful; this study must wait until the biochemical aetiology is clearer than at present.

Mineral metabolism in affective disorders

Physiological research has shown the fundamental importance of electrolytes in the functioning of the cell. According to the ionic theory, the resting and action potentials of nerve and muscle cells depend on potassium, sodium, chloride and other ions having a different concentration inside the cell to the concentration they have in the extracellular fluid. The cell membrane is freely permeable to potassium and chloride, but is much less permeable to sodium, and there is active transport of sodium which keeps the sodium concentration within the cell at about 1/10 of the concentration of sodium in the extracellular space. Because of this uneven distribution of sodium and the presence within the cell of impermeable anions (such as glutamic acid), potassium and chlorine are also unevenly divided between the cell and the extracellular fluid; potassium has a very high intracellular concentration and chlorine a low intracellular concentration compared to their concentration in the extracellular space.