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Kessing LV. Why is lithium [not] the drug of choice for bipolar disorder? a controversy between science and clinical practice. Int J Bipolar Disord 2024; 12:3. [PMID: 38228882 DOI: 10.1186/s40345-023-00322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND During over half a century, science has shown that lithium is the most efficacious treatment for bipolar disorder but despite this, its prescription has consistently declined internationally during recent decades to approximately 35% ever use or less of patients with bipolar disorder. CONTENT This narrative review provides an overview of the decreasing use of lithium in bipolar disorder internationally, shortly summarises the evidence for lithium's acute and prophylactic effects in bipolar disorder, discuss the challenges in relation to lithium including side effects, long-term risks and myths around lithium and provides two detailed examples on how specialised care models may result in successful increase of the use of lithium to 70% of patients with bipolar disorder largescale and improve care regionally and nationally. CONCLUSIONS Decades of scientific investigations and education and teaching of clinicians and the public has not increased the use of lithium on a population-based large scale. It is argued that lithium should be the drug of choice for maintenance therapy as the single first-line treatment and that organizational changes are needed with specialised care for bipolar disorder to systematically and long-term change the use of lithium on a large-scale population-level.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Center Copenhagen, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Zhuo C, Chen G, Chen J, Tian H, Ma X, Li Q, Yang L, Zhang Q, Li R, Song X, Huang C. Lithium bidirectionally regulates depression- and mania-related brain functional alterations without worsening cognitive function in patients with bipolar disorder. Front Psychiatry 2022; 13:963005. [PMID: 36186884 PMCID: PMC9520085 DOI: 10.3389/fpsyt.2022.963005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 01/10/2023] Open
Abstract
Lithium monotherapy has been proposed to have antidepressant and antimanic effects in patients with bipolar disorder (BP). However, so far, it is lack of evidence to support this proposition. The main aim of this study was to test the hypothesis that lithium bidirectionally regulates depression- and mania-related brain functional abnormalities in patients with BP. We also assessed the effects of lithium, alone and in combination with other pharmacological treatments, on patients' cognitive performance. We enrolled 149 drug-naïve patients with BP; 99 patients experiencing first depressive episodes were allocated randomly to four treatment groups [lithium (DP/Li), lithium with lamotrigine (LTG; DP/Li+LTG), LTG (DP/LTG), and valproate (VPA) with LTG (DP/VPA+LTG)], and 50 experiencing first hypo-manic episodes were allocated to two treatment groups (MA/Li and MA/VPA). For comparative analysis, 60 age-matched healthy individuals were also recruited. Whole-brain global and regional resting-state cerebral blood flow (rs-CBF) and cognitive alterations were examined before and after 12-week treatment. We have the following findings: DP/Li+LTG, and to a lesser extent DP/Li, alleviated the depression-related reduction in rs-CBF. MA/VPA and MA/Li reversed the mania-related elevation of rs-CBF completely and partially, respectively. Lithium alone improved cognitive performance during depressive and manic episodes; other tested treatments have no such effect or worsened cognitive ability. Our results showed that lithium bidirectionally regulates depression- and mania-associated brain functional abnormalities in patients with BP. Lithium monotherapy has a better antimanic effect than VPA, is superior to other tested treatments in improving cognition during the course of BP, and has satisfactory antidepressant effects in patients with BP.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.,Key Laboratory of Psychiatric-Neuroimaging-Genetics Laboratory (PNGC_Lab), Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China.,Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangdong Chen
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jiayue Chen
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China
| | - Hongjun Tian
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China
| | - Xiaoyan Ma
- Key Laboratory of Psychiatric-Neuroimaging-Genetics Laboratory (PNGC_Lab), Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Qianchen Li
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China
| | - Lei Yang
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China
| | - Qiuyu Zhang
- Key Laboratory of Real Time Tracing of Brain Circuits of Neurology and Psychiatry (RTBNP_Lab), Tianjin Fourth Center Hospital Affiliated to Tianjin Medical University, Tianjin Fourth Center Hospital, Tianjin, China
| | - Ranli Li
- Key Laboratory of Psychiatric-Neuroimaging-Genetics Laboratory (PNGC_Lab), Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunhai Huang
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
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Simonetti A, Koukopoulos AE, Kotzalidis GD, Janiri D, De Chiara L, Janiri L, Sani G. Stabilization Beyond Mood: Stabilizing Patients With Bipolar Disorder in the Various Phases of Life. Front Psychiatry 2020; 11:247. [PMID: 32395107 PMCID: PMC7197486 DOI: 10.3389/fpsyt.2020.00247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There are different ways to define stabilization and currently, the main standpoint regards it as no-depression/no-mania. Furthermore, each person is physiologically different from childhood to adulthood, and in old age, thus the meaning of stabilization should take into account both growth and maturity. We aimed to review systematically studies focusing on mood stabilization in all phases of bipolar disorder (BD) and across all life phases, including pregnancy and the perinatal period, which is still a different phase in women's life cycles. METHODS We carried out a PubMed search focusing on studies of bipolar disorder treated with drugs and aimed at stabilization with the following search strategy stabiliz*[ti] OR stabilis*[ti] OR stable[ti] OR stability[ti]) AND mood[ti] AND bipolar. In conducting our review, we followed the PRISMA statement. Agreement on inclusion was reached by consensus of all authors through a Delphi rounds procedure. RESULTS The above search strategy produced 509 records on January 25, 2020. Of them, 58 fitted our inclusion criteria and were discussed. The eligible studies spanned from September 1983 to July 6, 2019. CONCLUSIONS No clear-cut indications could be drawn due to a number of limitations involving sample inconsistency and different methods of assessing mood stabilization. The evidence collected so far does not allow recommended treatments for Adolescents, pregnant or perinatal women, and aged patients. However, adults, not within these groups, better focused upon. For their manic/mixed phases, second generation antipsychotic drugs may be useful in the short-to-medium run, alone or combined with mood stabilizers (MSs). However, MSs, and especially lithium, continue to be pivotal in chronic treatment. Bipolar depression should rely on MSs, but an antidepressant may be added on and can prove to be helpful. However, there are concerns with the tendency of antidepressants to induce the opposite polarity or mood instability, rendering the need for concurrent MS prescription mandatory.
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Affiliation(s)
- Alessio Simonetti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Alexia E Koukopoulos
- Centro Lucio Bini, Rome, Italy.,Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza School of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Georgios D Kotzalidis
- Centro Lucio Bini, Rome, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Delfina Janiri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.,Centro Lucio Bini, Rome, Italy
| | - Lavinia De Chiara
- Centro Lucio Bini, Rome, Italy.,NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Malhi GS, Porter R, Irwin L, Hamilton A, Morris G, Bassett D, Baune BT, Boyce P, Hopwood MJ, Mulder R, Parker G, Mannie Z, Outhred T, Das P, Singh AB. Defining a mood stabiliser: novel framework for research and clinical practice. BJPsych Open 2018; 4:278-281. [PMID: 30083379 PMCID: PMC6066982 DOI: 10.1192/bjo.2018.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED The term 'mood stabiliser' is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties - their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice. DECLARATION OF INTEREST The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
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Affiliation(s)
- Gin S Malhi
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Richard Porter
- Treatment Algorithm Group (TAG) and Department of Psychological Medicine, University of Otago - Christchurch, New Zealand
| | - Lauren Irwin
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Amber Hamilton
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Grace Morris
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Darryl Bassett
- Treatment Algorithm Group (TAG) and University of Western Australian Medical School, Australia, Faculty of Health and Medical Science, University of Western Australia, Australia
| | - Bernhard T Baune
- Treatment Algorithm Group (TAG) and Discipline of Psychiatry, University of Adelaide, Australia
| | - Philip Boyce
- Treatment Algorithm Group (TAG) and Discipline of Psychiatry, Sydney Medical School, Australia and Westmead Clinical School, University of Sydney, Australia
| | - Malcolm J Hopwood
- Treatment Algorithm Group (TAG) and Department of Psychiatry, University of Melbourne, Australia
| | - Roger Mulder
- Treatment Algorithm Group (TAG) and Department of Psychological Medicine, University of Otago - Christchurch, New Zealand
| | - Gordon Parker
- Treatment Algorithm Group (TAG) and School of Psychiatry, University of New South Wales, Australia and Black Dog Institute, Australia
| | - Zola Mannie
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Tim Outhred
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Pritha Das
- Treatment Algorithm Group (TAG), Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney Medical School Northern, University of Sydney, Australia and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Ajeet B Singh
- Treatment Algorithm Group (TAG) and School of Medicine, IMPACT Strategic Research Centre, Deakin University, Barwon Health, Australia
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