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Marques AR, Alho A, Martins JM, Bairrão M. Lithium Intoxication after Bariatric Surgery: A Case Report. ACTA MEDICA PORT 2021; 34:382-386. [PMID: 32955414 DOI: 10.20344/amp.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 11/20/2022]
Abstract
Bariatric surgery is a therapeutic option to treat obesity in (carefully selected) patients with psychiatric disorders. About half of the patients referred for bariatric surgery have a diagnosis of (at least one) mental disorder and most of them are treated with psychotropic drugs. This procedure may modify the bioavailability of drugs and lithium is no exception. However, although absorption seems to decrease in most drugs, in the case of lithium, there is a high risk of toxicity. In this article, we describe the case of a 44-year-old female patient with lithium intoxication after bariatric surgery. We conducted a review of the published clinical cases in the scientific literature about lithium toxicity after bariatric surgery, and we propose potential preventive clinical solutions. It is essential to increase awareness of changes to the absorption of psychotropic drugs in the post-surgery period, particularly in the case of lithium. Regular postoperative clinical and laboratory monitoring of lithium serum levels is strongly recommended.
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Affiliation(s)
| | - António Alho
- Departamento de Psiquiatria e Saúde Mental. Hospital Distrital de Santarém. Santarém. Portugal
| | - João Malhadas Martins
- Departamento de Psiquiatria e Saúde Mental. Hospital Distrital de Santarém. Santarém. Portugal
| | - Margarida Bairrão
- Departamento de Psiquiatria e Saúde Mental. Hospital Distrital de Santarém. Santarém. Portugal
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McCall WV. Editor's Roundup for Issue 1 of 2021: The Role of Electroconvulsive Therapy in the Correctional System, in Transgender Patients, Patients With Schizophrenia on Chronic Maintenance Electroconvulsive Therapy, and New Reflections on Lithium and Electroconvulsive Therapy. J ECT 2021; 37:1. [PMID: 33600116 DOI: 10.1097/yct.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Santa Cruz EC, Madrid KC, Arruda MAZ, Sussulini A. Association between trace elements in serum from bipolar disorder and schizophrenia patients considering treatment effects. J Trace Elem Med Biol 2020; 59:126467. [PMID: 31954929 DOI: 10.1016/j.jtemb.2020.126467] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/03/2020] [Accepted: 01/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Imbalances in metal concentrations have been suggested to contribute to the pathophysiology of different brain disorders, such as bipolar disorder (BD) and schizophrenia (SCZ). OBJECTIVES The aim of this exploratory study is to evaluate the association between the concentrations of macro/trace elements in serum from BD and SCZ patients considering the effects from different treatments. METHODS Eleven subjects with SCZ, seven with BD treated with lithium (BDL) and eight subjects with BD treated with other medications except lithium (BDN) were recruited for the study, as well as eleven healthy controls (HC). Serum concentrations of eleven macro/trace elements (Se, Zn, Fe, K, Ca, Mg, P, Al, Cu, Mn, and Ni) were determined using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS Se and Zn concentrations were significantly lower for patients with SCZ and BD in comparison to HC by one-way ANOVA test. Moreover, serum concentrations for Fe were significantly higher (p < 0.05) in BDN (548 ± 92 μg L-1) and SCZ (632 ± 279 μg L-1) in comparison to HC (421 ± 121 μg L-1). A significant negative correlation was reported between Se and Fe in BDL group (r = -0.935, p < 0.05). In addition, a significantly higher Cu/Zn ratio was determined in SCZ group against HC (ratio = 2.4, p = 0.028). CONCLUSIONS The obtained results suggest that the imbalance in Fe concentrations is an effect of BD treatment. Lithium is supposed to have an antagonist effect for Se in BDL patients. A negative correlation reported between Fe and BMI in SCZ group could be related to antipsychotic treatment and the Cu/Zn ratio reported could be considered as a suggesting parameter to relate oxidative stress to SCZ. Future studies including larger number of patients with SCZ and BD before and after treatment are necessary to confirm the investigative results presented herein.
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Affiliation(s)
- Elisa C Santa Cruz
- Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Department of Analytical Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil
| | - Katherine C Madrid
- Spectrometry, Sample Preparation and Mechanization Group (GEPAM), Department of Analytical Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil
| | - Marco A Z Arruda
- Spectrometry, Sample Preparation and Mechanization Group (GEPAM), Department of Analytical Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil; National Institute of Science and Technology for Bioanalytics - INCTBio, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil
| | - Alessandra Sussulini
- Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Department of Analytical Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil; National Institute of Science and Technology for Bioanalytics - INCTBio, Institute of Chemistry, University of Campinas (UNICAMP), P.O. Box 6154, 13083-970, Campinas, SP, Brazil.
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Ettenberg A, Ayala K, Krug JT, Collins L, Mayes MS, Fisher MPA. Differential effects of lithium isotopes in a ketamine-induced hyperactivity model of mania. Pharmacol Biochem Behav 2020; 190:172875. [PMID: 32084493 DOI: 10.1016/j.pbb.2020.172875] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/06/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
Sub-anesthetic doses of ketamine produce an increase in rodent ambulation that is attenuated by co-administration of naturally-occurring lithium (LiN), the drug most commonly employed in the treatment of bipolar illness. As a consequence, ketamine-induced hyperactivity has been proposed as an animal model of manic behavior. The current study employed a modified version of this model to compare the potency of LiN to that of each of its two stable isotopes - lithium-6 (Li-6) and lithium-7 (Li-7). Since Li-7 constitutes 92.4% of the parent compound it was hypothesized to produce comparable behavioral effects to that of LiN. The current study was devised to determine whether Li-6 might be more, less, or equally effective at tempering hyperactivity relative to Li-7 or to LiN in an animal model of manic behavior. Male rats were maintained on a restricted but high-incentive diet containing a daily dose of 2.0 mEq/kg of lithium (LiN), Li-6 or Li-7 for 30 days. A control group consumed a diet infused with sodium chloride (NaCl) in place of lithium to control for the salty taste of the food. On day 30, baseline testing revealed no differences in the locomotor behavior among the four treatment groups. Animals then continued their Li/NaCl diets for an additional 11 days during which every subject received a single IP injection of either ketamine (25 mg/kg) or 0.9% physiological saline. On the final four days of this regimen, locomotor activity was assessed during 60 min sessions each beginning immediately after ketamine injection. While all three lithium groups produced comparable decreases in ketamine-induced hyperactivity on the first trial, by the fourth trial Li-6 animals exhibited significantly greater and more prolonged reductions in hyperactivity compared to either Li-7 and Li. These results suggest that Li-6 may be more effective at treating mania than its parent compound.
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Affiliation(s)
- Aaron Ettenberg
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA.
| | - Kathy Ayala
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA
| | - Jacob T Krug
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA
| | - Lisette Collins
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA
| | - Matthew S Mayes
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA 93106, USA
| | - Matthew P A Fisher
- Department of Physics, University of California, Santa Barbara, CA 93106, USA
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Menegas S, Dal-Pont GC, Cararo JH, Varela RB, Aguiar-Geraldo JM, Possamai-Della T, Andersen ML, Quevedo J, Valvassori SS. Efficacy of folic acid as an adjunct to lithium therapy on manic-like behaviors, oxidative stress and inflammatory parameters in an animal model of mania. Metab Brain Dis 2020; 35:413-425. [PMID: 31840201 DOI: 10.1007/s11011-019-00503-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
Evaluate the efficacy of folic acid (FA) as a therapeutic adjunct to lithium (Li) on the manic-like behaviors as well as parameters of oxidative stress and inflammation in an animal model of mania induced by m-amphetamine (m-AMPH). Wistar rats first received m-AMPH or saline (NaCl 0.9%, Sal) for 14 days. Between the 8th and 14th day, rats were treated with water, Li, FA or a combination of thereof drugs (Li + FA). Manic-like behaviors were assessed in the open-field test. Oxidative stress and inflammation parameters were assessed in the frontal cortex, striatum, and hippocampus. Administration of m-AMPH in rats significantly enhanced the exploratory and locomotor behaviors, as well as the risk-taking and stereotypic behaviors. Li + FA reversed these behavioral alterations elicited by m-AMPH. Administration of this psychostimulant also increased oxidative damage to lipids and proteins, whereas Li + FA reversed these oxidative damages. m-AMPH also induced an increase in the glutathione peroxidase (GPx) activity and a decrease in the glutathione reductase (GR) activity. Li + FA reversed the alteration in GR activity, but not in GPx activity. In addition, m-AMPH increased the IL-1β and TNF-α levels in the rat brain; Li + FA combined therapy reversed the alterations on these inflammatory parameters. FA administration per se reduced the increased TNF-α content induced by m-AMPH. Present study provides evidence that FA is effective as an adjunct to Li standard therapy on manic-like behaviors, oxidative stress and inflammatory parameters in a model of mania induced by m-AMPH.
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Affiliation(s)
- Samira Menegas
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Gustavo C Dal-Pont
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - José H Cararo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Roger B Varela
- Queensland Brain Institute, The Universty of Queensland, St Lucia, QLD, 4072, Australia
| | - Jorge M Aguiar-Geraldo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Taise Possamai-Della
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Monica L Andersen
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - João Quevedo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Samira S Valvassori
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Conan GM. Frequently overlooked realistic moral bioenhancement interventions. J Med Ethics 2020; 46:43-47. [PMID: 31462452 DOI: 10.1136/medethics-2019-105534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
Many supporters of 'moral bioenhancement' (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants-the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE.
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Szklarska D, Rzymski P. Is Lithium a Micronutrient? From Biological Activity and Epidemiological Observation to Food Fortification. Biol Trace Elem Res 2019; 189:18-27. [PMID: 30066063 PMCID: PMC6443601 DOI: 10.1007/s12011-018-1455-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 12/17/2022]
Abstract
Lithium compounds have been widely used in psychopharmacology, particularly in the treatment of bipolar disorder. Their normothymic and neuroprotective properties when used at high doses have been well established. However, a number of observations suggest that environmentally relevant lithium doses may also exert beneficial health effects, leading to a decrease in the rate of suicides and levels of violence. Despite the fact that this element is not officially considered to be a micronutrient, some authors have suggested provisional recommended intakes set at 1000 μg/day for a 70-kg adult (14.3 μg/kg body weight). The present paper reviews the biological action of lithium, its bioavailability and metabolism, and content in different foodstuffs and water. It also assesses epidemiological data on potential correlations between lithium intake and suicide rate as well as examines the concept of fortifying food with this element as a strategy in the primary prevention of mood disorders and pre-suicidal syndrome.
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Affiliation(s)
- Daria Szklarska
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznań, Poland.
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SACHER RONALDA. PRESIDENT'S ADDRESS: WINE, WATER, AND WELLNESS. Trans Am Clin Climatol Assoc 2019; 130:1-23. [PMID: 31516160 PMCID: PMC6735988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- RONALD A. SACHER
- Correspondence and reprint requests: Ronald A. Sacher, MD, University of Cincinnati Academic Health Center,
3130 Highland Avenue, P.O. Box 670055, Cincinnati, Ohio 45267-0055513-558-1300
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Thomas L, Xue J, Dominguez Rieg JA, Rieg T. Contribution of NHE3 and dietary phosphate to lithium pharmacokinetics. Eur J Pharm Sci 2018; 128:1-7. [PMID: 30419292 DOI: 10.1016/j.ejps.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/09/2018] [Accepted: 11/08/2018] [Indexed: 01/13/2023]
Abstract
Lithium is one of the mainstays for the treatment of bipolar disorder despite its side effects on the endocrine, neurological, and renal systems. Experimentally, lithium has been used as a measure to determine proximal tubule reabsorption based on the assumption that lithium and sodium transport go in parallel in the proximal tubule. However, the exact mechanism by which lithium is reabsorbed remains elusive. The majority of proximal tubule sodium reabsorption is directly or indirectly mediated by the sodium-hydrogen exchanger 3 (NHE3). In addition, sodium-phosphate cotransporters have been implicated in renal lithium reabsorption. In order to better understand the role of sodium-phosphate cotransporters involved in lithium (re)absorption, we studied lithium pharmacokinetics in: i) tubule-specific NHE3 knockout mice (NHE3loxloxPax8Cre), and ii) mice challenged with low or high phosphate diets. Intravenous or oral administration of lithium did not result in differences in lithium bioavailability, half-life, maximum plasma concentrations, area under the curve, lithium clearance, or urinary lithium/creatinine ratios between control and NHE3loxloxPax8Cre mice. After one week of dietary phosphate challenges, lithium bioavailability was ~30% lower on low versus high dietary phosphate, possibly the consequence of a smaller area under the curve after oral administration. This was associated with higher apparent lithium clearance after oral administration and lower urinary lithium/creatinine ratios on low versus high dietary phosphate. Collectively, renal NHE3 does not play a role in lithium pharmacokinetics; however, dietary phosphate could have an indirect effect on lithium bioavailability and lithium disposition.
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Affiliation(s)
- Linto Thomas
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
| | - Jianxiang Xue
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
| | - Jessica A Dominguez Rieg
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA
| | - Timo Rieg
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33612, USA.
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Scanni A, Tomirotti M, Berra S, Licciardello L, Felicetta I, Bertolini G, Bregni M. Lithium Carbonate in the Treatment of Drug-Induced Leukopenia in Patients with Solid Tumors. Tumori 2018; 66:729-37. [PMID: 7015644 DOI: 10.1177/030089168006600607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report on the first part of an ongoing: controlled trial (52 cases) on the evaluation of the effectiveness of Li2CO3 treatment of drug-induced leukopenia in patients with solid tumors. The results indicate that treatment with 750 mg/day per os of Li2CO3 for 7 days is capable of raising the leukocyte count to a highly significant extent, without serious side effects. The leukocytosis is due to an increase in neutrophil granulocytes.
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Abstract
INTRODUCTION Because the multimodal antidepressant vortioxetine is likely to be coadministered with other central nervous system (CNS)-active drugs, potential drug-drug interactions warrant examination. OBJECTIVE These studies evaluated whether there are pharmacokinetic and/or pharmacodynamic interactions between vortioxetine and ethanol, diazepam, or lithium. METHODS This series of phase I studies included healthy men and women (only men in the lithium study) aged 18-45 years. The ethanol study was a randomized, double-blind, two-parallel group, four-period crossover study in which subjects received a single dose of vortioxetine (20 or 40 mg) or placebo with or without ethanol, and the diazepam study was a randomized, double-blind, placebo-controlled, two-sequence, two-period crossover study in which subjects received a single dose of diazepam following multiple doses of vortioxetine 10 mg/day or placebo. These two studies evaluated the effect of coadministration on standardized psychomotor parameters and on selected pharmacokinetic parameters of each drug. The lithium study was a single-blind, single-sequence study evaluating the effect of multiple doses of vortioxetine 10 mg/day on the steady-state pharmacokinetics of lithium. RESULTS Concomitant administration of vortioxetine and single doses of either ethanol or diazepam had no significant effect on the psychomotor performance of subjects compared with administration of ethanol or diazepam alone. Vortioxetine had no significant effect on the pharmacokinetics of ethanol, diazepam, or lithium, and ethanol had no significant effect on the pharmacokinetics of vortioxetine. CONCLUSIONS Concomitant administration of these agents with vortioxetine was generally well tolerated, with no clinically relevant drug-drug pharmacokinetic or pharmacodynamic interactions identified.
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Affiliation(s)
- Grace Chen
- Clinical Pharmacology, Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA.
| | - George G Nomikos
- Clinical Science, Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
| | - John Affinito
- Pharmacovigilance, Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
| | - Zhen Zhao
- Analytical Science, Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA
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Zhou K, Xie C, Wickström M, Dolga AM, Zhang Y, Li T, Xu Y, Culmsee C, Kogner P, Zhu C, Blomgren K. Lithium protects hippocampal progenitors, cognitive performance and hypothalamus-pituitary function after irradiation to the juvenile rat brain. Oncotarget 2017; 8:34111-34127. [PMID: 28415806 PMCID: PMC5470955 DOI: 10.18632/oncotarget.16292] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/01/2017] [Indexed: 11/25/2022] Open
Abstract
Cranial radiotherapy in children typically causes delayed and progressive cognitive dysfunction and there is no effective preventive strategy for radiation-induced cognitive impairments. Here we show that lithium treatment reduced irradiation-induced progenitor cell death in the subgranular zone of the hippocampus, and subsequently ameliorated irradiation-reduced neurogenesis and astrogenesis in the juvenile rat brain. Irradiation-induced memory impairment, motor hyperactivity and anxiety-like behaviour were normalized by lithium treatment. Late-onset irradiation-induced hypopituitarism was prevented by lithium treatment. Additionally, lithium appeared relatively toxic to multiple cultured tumour cell lines, and did not improve viability of radiated DAOY cells in vitro. In summary, our findings demonstrate that lithium can be safely administered to prevent both short- and long-term injury to the juvenile brain caused by ionizing radiation.
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Affiliation(s)
- Kai Zhou
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden
| | - Cuicui Xie
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Malin Wickström
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Amalia M. Dolga
- Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany
- Department of Molecular Pharmacology, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Yaodong Zhang
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Tao Li
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Paediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yiran Xu
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carsten Culmsee
- Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany
| | - Per Kogner
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden
- Department of Paediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Changlian Zhu
- Centre for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Klas Blomgren
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden
- Department of Paediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
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Dehning J, Grunze H, Born C, Hausmann A. [Lithium treatment in patients with impaired kidney function: Between Scylla and Charybdis]. Fortschr Neurol Psychiatr 2017; 85:288-291. [PMID: 28561179 DOI: 10.1055/s-0043-106739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction In quite a few patients with bipolar disorder there is no real alternative to lithium treatment despite impaired kidney function. Is it possible to continue lithium treatment despite kidney malfunction by changing dosage and/or frequency of administration? Case Report We report on a 65-year-old woman suffering from bipolar-I disorder who had been on lithium treatment for many decades. While on lithium, the glomerular filtration rate (GFR) decreased constantly. A decision had to be made whether to switch to a more tolerable o.d. administration or to taper off lithium. Conclusion With a single dose at bedtime, the serum levels remained stable; however, kidney function unfortunately did not improve. A relevant increase of GFR above the level of 60 mL/min/1,73 m2 was only achieved after a 50% dose reduction leading also to a substantial decrease of lithium serum levels. A kidney protective lithium application in patients with reduced renal function is like sailing between Scylla and Charybdis.
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Affiliation(s)
| | - Heinz Grunze
- Paracelsus Medizinische Privatuniversität
- Suchtkrankenhilfe d. Evang. Stadtmission Heidelberg gGmbH
| | - Christoph Born
- Paracelsus Medizinische Privatuniversität
- Christian-Doppler-Klinik
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Lawson A, Dalfen A. Examination of a four-step treatment algorithm for postpartum psychosis. Evid Based Ment Health 2016; 19:25. [PMID: 26701386 PMCID: PMC10699344 DOI: 10.1136/eb-2015-102107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/14/2015] [Accepted: 12/04/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Andrea Lawson
- Department of Psychiatry, Mount Sinai Hospital, University of Toronto, 600 University Ave, 9th Floor, Toronto, Ontario, Canada M5G 1X5
| | - Ariel Dalfen
- Department of Psychiatry, Mount Sinai Hospital, University of Toronto, 600 University Ave, 9th Floor, Toronto, Ontario, Canada M5G 1X5
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Kiełczykowska M, Kocot J, Żelazowska R, Lewandowska A, Musik I. The study of possible application of sodium selenite as an adjuvant in lithium treatment: an effect on oxidative processes in heart of rats. Eur Rev Med Pharmacol Sci 2015; 19:3947-3954. [PMID: 26531284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Despite numerous side effects, including heart disturbances, lithium is still used in medicine. Selenium treatment can protect against toxicity of harmful substances and side effects of other drugs. In this study possibility of sodium selenite application as an adjuvant in lithium treatment was studied. MATERIALS AND METHODS Male Wistar rats were treated with: control - saline; Li group - Li2CO3 (2.7 mg Li/kg b.w.); Se group - Na2SeO3 (0.5 mg Se/kg b.w.); Li+Se group simultaneously with Li2CO3 and Na2SeO3 (2.7 mg Li/kg b.w. and 0.5 mg Se/kg b.w., respectively) by stomach tube for a period of six weeks, once a day. In heart homogenates total antioxidant status (TAS), activities of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) as well as concentrations of ascorbic acid (AA), reduced glutathione (GSH) and malonyldialdehyde (MDA) were determined. SOD/GPx, CAT/GPx and SOD/CAT ratios were evaluated. RESULTS TAS was insignificantly increased, particularly in groups receiving selenium. GPx was slightly decreased in Li group and partially restored by Li+Se treatment. Selenium markedly enhanced AA concentration vs. CONTROL MDA was increased significantly in Li and Se groups and restored in Li+Se treated. SOD/GPx and CAT/GPx. Ratios were slightly increased in Li group and restored by selenium co-administration. CONCLUSIONS As Li+Se treatment resulted in no significant differences vs. control and restored MDA, SOD/GPx and CAT/GPx ratios. Research on selenium application during lithium therapy seems to be worth continuation.
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Affiliation(s)
- M Kiełczykowska
- Chair and Department of Medical Chemistry, Medical University of Lublin, Lublin, Poland.
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Pinacho R, Saia G, Fusté M, Meléndez-Pérez I, Villalta-Gil V, Haro JM, Gill G, Ramos B. Phosphorylation of transcription factor specificity protein 4 is increased in peripheral blood mononuclear cells of first-episode psychosis. PLoS One 2015; 10:e0125115. [PMID: 25915526 PMCID: PMC4411105 DOI: 10.1371/journal.pone.0125115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/20/2015] [Indexed: 12/20/2022] Open
Abstract
Background Altered expression of transcription factor specificity protein 4 (SP4) has been found in the postmortem brain of patients with psychiatric disorders including schizophrenia and bipolar disorder. Reduced levels of SP4 protein have recently been reported in peripheral blood mononuclear cells in first-episode psychosis. Also, SP4 levels are modulated by lithium treatment in cultured neurons. Phosphorylation of SP4 at S770 is increased in the cerebellum of bipolar disorder subjects and upon inhibition of NMDA receptor signaling in cultured neurons. The aim of this study was to investigate whether SP4 S770 phosphorylation is increased in lymphocytes of first-episode psychosis patients and the effect of lithium treatment on this phosphorylation. Methods A cross-sectional study of S770 phosphorylation relative to total SP4 immunoreactivity using specific antibodies in peripheral blood mononuclear cells in first-episode psychosis patients (n = 14, treated with lithium or not) and matched healthy controls (n = 14) by immunoblot was designed. We also determined the effects of the prescribed drugs lithium, olanzapine or valproic acid on SP4 phosphorylation in rat primary cultured cerebellar granule neurons. Results We found that SP4 S770 phosphorylation was significantly increased in lymphocytes in first-episode psychosis compared to controls and decreased in patients treated with lithium compared to patients who did not receive lithium. Moreover, incubation with lithium but not olanzapine or valproic acid reduced SP4 phosphorylation in rat cultured cerebellar granule neurons. Conclusions The findings presented here indicate that SP4 S770 phosphorylation is increased in lymphocytes in first-episode psychosis which may be reduced by lithium treatment in patients. Moreover, our study shows lithium treatment prevents this phosphorylation in vitro in neurons. This pilot study suggests that S770 SP4 phosphorylation could be a peripheral biomarker of psychosis, and may be regulated by lithium treatment in first-episode psychosis.
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Affiliation(s)
- Raquel Pinacho
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Gregory Saia
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Cell, Molecular and Developmental Biology Program, Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Montserrat Fusté
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Iria Meléndez-Pérez
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Victoria Villalta-Gil
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Grace Gill
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail: (BR); (GG)
| | - Belén Ramos
- Unitat de recerca, Fundació Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- * E-mail: (BR); (GG)
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Goetz CG, Klawans HL, Carvey P. Animal models of tardive dyskinesia: their use in the search for new treatment methods. Mod Probl Pharmacopsychiatry 2015; 21:5-20. [PMID: 6140633 DOI: 10.1159/000408479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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19
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Kerry RJ. Practical guide-lines of lithium prophylaxis. Bibl Psychiatr 2015:197-205. [PMID: 7271754 DOI: 10.1159/000395826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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20
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Monden MAH, Nederkoorn PJ, Tijsma M. [Downbeat nystagmus - a rare side-effect of lithium carbonate]. Tijdschr Psychiatr 2015; 57:49-53. [PMID: 25601629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 52-year-old woman who had been treated with lithium carbonate for 10 years developed a downbeat nystagmus. The literature describes downbeat nystagmus as a rare side-effect of lithium carbonate. In this patient other causes of downbeat nystagmus were ruled out. In most cases stopping lithium carbonate does not alleviate the symptoms, which are often debilitating. At the moment there is no adequate treatment for the condition. In some cases, however, the symptoms subside after the patient stops taking lithium. Therefore, we consider that early recognition of downbeat nystagmus in patients being treated with lithium carbonate is vitally important.
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Thorfve A, Bergstrand A, Ekström K, Lindahl A, Thomsen P, Larsson A, Tengvall P. Gene expression profiling of peri-implant healing of PLGA-Li+ implants suggests an activated Wnt signaling pathway in vivo. PLoS One 2014; 9:e102597. [PMID: 25047349 PMCID: PMC4105622 DOI: 10.1371/journal.pone.0102597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/20/2014] [Indexed: 01/09/2023] Open
Abstract
Bone development and regeneration is associated with the Wnt signaling pathway that, according to literature, can be modulated by lithium ions (Li+). The aim of this study was to evaluate the gene expression profile during peri-implant healing of poly(lactic-co-glycolic acid) (PLGA) implants with incorporated Li+, while PLGA without Li+ was used as control, and a special attention was then paid to the Wnt signaling pathway. The implants were inserted in rat tibia for 7 or 28 days and the gene expression profile was investigated using a genome-wide microarray analysis. The results were verified by qPCR and immunohistochemistry. Histomorphometry was used to evaluate the possible effect of Li+ on bone regeneration. The microarray analysis revealed a large number of significantly differentially regulated genes over time within the two implant groups. The Wnt signaling pathway was significantly affected by Li+, with approximately 34% of all Wnt-related markers regulated over time, compared to 22% for non-Li+ containing (control; Ctrl) implants. Functional cluster analysis indicated skeletal system morphogenesis, cartilage development and condensation as related to Li+. The downstream Wnt target gene, FOSL1, and the extracellular protein-encoding gene, ASPN, were significantly upregulated by Li+ compared with Ctrl. The presence of β-catenin, FOSL1 and ASPN positive cells was confirmed around implants of both groups. Interestingly, a significantly reduced bone area was observed over time around both implant groups. The presence of periostin and calcitonin receptor-positive cells was observed at both time points. This study is to the best of the authors' knowledge the first report evaluating the effect of a local release of Li+ from PLGA at the fracture site. The present study shows that during the current time frame and with the present dose of Li+ in PLGA implants, Li+ is not an enhancer of early bone growth, although it affects the Wnt signaling pathway.
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Affiliation(s)
- Anna Thorfve
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Anna Bergstrand
- Department of Chemical and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- SuMo BIOMATERIALS VINN Excellence Center, Gothenburg, Sweden
- Stiftelsen Chalmers Industriteknik, Chalmers Teknikpark, Gothenburg, Sweden
| | - Karin Ekström
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Anders Lindahl
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Anette Larsson
- Department of Chemical and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
- SuMo BIOMATERIALS VINN Excellence Center, Gothenburg, Sweden
| | - Pentti Tengvall
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
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González-Weller D, Rubio C, Gutiérrez ÁJ, González GL, Caballero Mesa JM, Revert Gironés C, Burgos Ojeda A, Hardisson A. Dietary intake of barium, bismuth, chromium, lithium, and strontium in a Spanish population (Canary Islands, Spain). Food Chem Toxicol 2013; 62:856-858. [PMID: 24416776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to analyze barium, bismuth, chromium, lithium, and strontium contents in food and beverages consumed by the population of the Canary Islands (Spain) as well as determine dietary intake of these metals in the archipelago as a whole and in its individual islands. To this end, 440 samples were analyzed by ICP-OES and GFAAS. Barium concentrations ranged from 5.210 ± 2.117 mg/kg in nuts to 0.035 ± 0.043 mg/L in water. Viscera exhibited the highest levels of bismuth (38.07 ± 36.80 mg/kg). The cold meat and sausages group stood out for its high chromium concentrations (0.494 ± 0.257 mg/kg). The highest concentration of lithium and strontium came out in nuts (8.761 ± 5.368 mg/kg and 9.759 ± 5.181 mg/kg, respectively). The total intakes of barium, bismuth, chromium, lithium, and strontium were 0.685, 1.274, 0.087, 3.674, and 1.923 mg/day, respectively. Cereals turned out to contribute most to the dietary intake of barium, bismuth, chromium, and lithium in the Canary Islands, while fruit contributes most to the strontium intake. We also performed a metal intake study by age and sex of the population and compared the outcome with data from other regions, both national and international.
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Antushevich AA, Antushevich AE, Grebeniuk AN, Tarumov RA, Antonov VG. [Experimental study of the therapeutic efficiency of the lithium salt of glutathione disulphide in the conditions of acute external gamma-irradiation]. Radiats Biol Radioecol 2013; 53:451-458. [PMID: 25434164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Experimental studies on white outbred male mice subjected to gamma-irradiation at doses LD(80/30) have found that the therapeutic use of Litan contributes to the increase (by 40-50%) in the survival rate of the animals. Introduction to irradiated animals of Litan increases the intensity of the inclusion of 3H-thymidine in the DNA of the bone marrow cells and is associated with a growing number of splenic endogenous colonies, which can testify to the stimulating influence of the drug on the proliferation and differentiation of hematopoietic cells, as well as on the deficit restoration of full-fledged mature cell forms in the peripheral blood.
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Abstract
The objective of this study was to assess the pharmacokinetics of the antipsychotic aripiprazole when coadministered with lithium or valproate. Two open-label, sequential treatment design studies were conducted in chronically institutionalized patients with schizophrenia or schizoaffective disorder requiring treatment with lithium (n = 12) or valproate (divalproex sodium) (n = 10). Patients received aripiprazole 30 mg/day on days 1 to 14 and aripiprazole with concomitant therapy on days 15 to 36. Lithium was titrated from 900 mg until serum concentrations reached 1.0 to 1.4 mEq/L for at least 5 days. Valproate was titrated to 50 to 125 mg/L. Coadministration with lithium increased mean Cmax and AUC values of aripiprazole by about 19% and 15%, respectively, whereas the apparent oral clearance decreased by 15%. There was no effect on the steady-state pharmacokinetics of the active metabolite of aripiprazole. Coadministration with valproate decreased the AUC and Cmax of aripiprazole by 24% and 26%, respectively, with minimal effects on the active metabolite. Therapeutic doses of lithium and divalproex had no clinically significant effects on the pharmacokinetics of aripiprazole in patients with schizophrenia or schizoaffective disorder.
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Affiliation(s)
- Leslie Citrome
- Nathan S. Kline Institute for Psychiatic Research and the Rockland Psychiatric Center, Orangeburg, NY 10962, USA
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Atagün MI, Oral ET, Sevinç C. [Polycystic kidney disease in a patient using lithium chronically]. Turk Psikiyatri Derg 2013; 24:213-216. [PMID: 24049011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Lithium remains to be the gold standard in the treatment of mood disorders. This study presents a case treated with lithium for an extended period with a good response. Following an increase in creatinine levels, further investigation of renal dysfunction revealed polycystic kidney disease. Lithium was used prior to the diagnosis of polycystic kidney disease, resulting in the unique opportunity to examine the effects of lithium on kidneys with polycystic kidney disease. Within this context, this study also discusses the pharmacokinetics of lithium, and its possible relation to cyst formation in polycystic kidney disease.
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Geeraerts I, Sienaert P. [Predictive methods versus clinical titration for the initiation of lithium therapy. A systematic review]. Tijdschr Psychiatr 2013; 55:761-771. [PMID: 24166336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND When lithium is administered, the clinician needs to know when the lithium in the patient’s blood has reached a therapeutic level. At the initiation of treatment the level is usually achieved gradually through the application of the titration method. In order to increase the efficacy of this procedure several methods for dosing lithium and for predicting lithium levels have been developed. AIM To conduct a systematic review of the publications relating to the various methods for dosing lithium or predicting lithium levels at the initiation of therapy. METHOD We searched Medline systematically for articles published in English, French or Dutch between 1966 and April 2012 which described or studied a method for dosing lithium or for predicting the lithium level reached following a specific dosage. We screened the reference lists of relevant articles in order to locate additional papers. RESULTS We found 38 lithium prediction methods, in addition to the clinical titration method. These methods can be divided into two categories: the ‘a priori’ methods and the ‘test-dose’ methods, the latter requiring the administration of a test dose of lithium. CONCLUSION The lithium prediction methods generally achieve a therapeutic blood level faster than the clinical titration method, but none of the methods achieves convincing results. On the basis of our review, we propose that the titration method should be used as the standard method in clinical practice.
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Abstract
Lithium is used as a mood stabilizer in patients with manic-depressive disorder. It is a drug that requires close monitoring due to its narrow therapeutic window and many side effects. There are several case reports of lithium side effects and toxicity occurring even at the therapeutic levels. Cardiac toxicity is observed in approximately 5% of patients; however, severe bradycardia caused by a single dose of lithium is exceedingly rare. We herein report a case of severe symptomatic bradycardia in a young man that occurred after a single dose of lithium. This case emphasizes the need to closely monitor patients when initiating therapy, even before the lithium levels are high enough to be detected.
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Affiliation(s)
- Manpreet S Sabharwal
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, USA
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Abu-Taweel GM. Effects of perinatal exposure of lithium on neuro-behaviour of developing mice offspring. Indian J Exp Biol 2012; 50:696-701. [PMID: 23214262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lithium (Li) was given to female Swiss-Webster strain mice at the doses of 15 and 30 mg/kg body weight in their drinking water. Treatment started from the first day of pregnancy until the postnatal day fifteen of delivery. Thereafter, the dams were switched to plain tap water. All offspring were subjected to various tests. The rate of body weight gain was relatively slower in Li exposed pups. Furthermore, the opening of eyes and appearance of body hairs in Li exposed pups were also slower as compared to the controls. The sensory motor reflexes in Li exposed pups were found to be affected in a dose-dependent manner. Significant relative changes were also noticed in the levels of acid and alkaline phosphatases in the liver, and acetylcholinesterase in the brain tissues of the Li exposed developing offspring in a dose-dependent manner. 'Locomotor Activity Test' was performed in the male offspring only which showed a significant suppressive effect on most of the elements of this test due to Li exposure. The present Li effects in the offspring are possibly via in utero action and/or via mother's milk.
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Affiliation(s)
- Gasem M Abu-Taweel
- Department of Biology, College of Education, Dammam University, P.O. Box 2375, Dammam 31451, Saudi Arabia.
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Katagiri H, Takita Y, Tohen M, Higuchi T, Kanba S, Takahashi M. Safety and efficacy of olanzapine monotherapy and olanzapine with a mood stabilizer in 18-week treatment of manic/mixed episodes for Japanese patients with bipolar I disorder. Curr Med Res Opin 2012; 28:701-13. [PMID: 22356118 DOI: 10.1185/03007995.2012.666961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of 18-week olanzapine monotherapy in Japanese patients with bipolar mania, following a 6-week, placebo- and haloperidol-controlled double-blind study (acute study). For those who discontinued the acute study due to lack of efficacy, safety and efficacy was assessed with a combination therapy of olanzapine and a mood stabilizer. RESEARCH DESIGN AND METHODS In this open-label, multicenter extension study, patients who completed the acute study received olanzapine (5-20 mg/day) as monotherapy, and patients who discontinued the acute study due to lack of efficacy with greater Young Mania Rating Scale (YMRS) total score than the acute study baseline, received olanzapine in combination with one of three mood stabilizers: lithium, carbamazepine, or valproate. Safety was assessed by treatment-emergent adverse events (TEAEs), vital signs, weight, and extrapyramidal symptoms (EPSs). Efficacy measures included YMRS total score, and response and remission rates of manic symptoms. MAIN OUTCOME AND MEASURES There were no deaths or serious adverse events considered potentially related to olanzapine in the monotherapy group (N = 100) or the combination-therapy group (N = 39). TEAEs occurred in 59.0% and 79.5% of patients in the monotherapy and combination-therapy groups, respectively, and their severities were mostly mild or moderate. Regarding the efficacy measures, in the monotherapy group, mean YMRS change from extension study baseline to endpoint was -3.0, and the response and remission rates at endpoint were 97.0% and 93.0%, respectively. In the combination-therapy group, mean YMRS change from extension-study baseline was -19.8; response and remission rates increased from the extension-study baseline (both 0.0%) to 64.1% and 61.5% respectively by endpoint. CONCLUSION Olanzapine was generally well tolerated during the 18-week extension period in Japanese patients with bipolar mania. Results of both groups were also generally consistent with US and European studies. Monitoring of metabolic parameters is recommended.
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Affiliation(s)
- Hideaki Katagiri
- Lilly Research Laboratories Japan, Eli Lilly Japan K.K., Kobe, Japan.
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Sudduth TL, Wilson JG, Everhart A, Colton CA, Wilcock DM. Lithium treatment of APPSwDI/NOS2-/- mice leads to reduced hyperphosphorylated tau, increased amyloid deposition and altered inflammatory phenotype. PLoS One 2012; 7:e31993. [PMID: 22347510 PMCID: PMC3276493 DOI: 10.1371/journal.pone.0031993] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/17/2012] [Indexed: 01/21/2023] Open
Abstract
Lithium is an anti-psychotic that has been shown to prevent the hyperphosphorylation of tau protein through the inhibition of glycogen-synthase kinase 3-beta (GSK3β). We recently developed a mouse model that progresses from amyloid pathology to tau pathology and neurodegeneration due to the genetic deletion of NOS2 in an APP transgenic mouse; the APPSwDI/NOS2−/− mouse. Because this mouse develops tau pathology, amyloid pathology and neuronal loss we were interested in the effect anti-tau therapy would have on amyloid pathology, learning and memory. We administered lithium in the diets of APPSwDI/NOS2−/− mice for a period of eight months, followed by water maze testing at 12 months of age, immediately prior to sacrifice. We found that lithium significantly lowered hyperphosphorylated tau levels as measured by Western blot and immunocytochemistry. However, we found no apparent neuroprotection, no effect on spatial memory deficits and an increase in histological amyloid deposition. Aβ levels measured biochemically were unaltered. We also found that lithium significantly altered the neuroinflammatory phenotype of the brain, resulting in enhanced alternative inflammatory response while concurrently lowering the classical inflammatory response. Our data suggest that lithium may be beneficial for the treatment of tauopathies but may not be beneficial for the treatment of Alzheimer's disease.
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Affiliation(s)
- Tiffany L. Sudduth
- University of Kentucky Sanders-Brown Center on Aging, Department of Physiology, Lexington, Kentucky, United States of America
| | - Joan G. Wilson
- Duke University Medical Center, Department of Medicine, Division of Neurology, Durham, North Carolina, United States of America
| | - Angela Everhart
- Duke University Medical Center, Department of Medicine, Division of Neurology, Durham, North Carolina, United States of America
| | - Carol A. Colton
- Duke University Medical Center, Department of Medicine, Division of Neurology, Durham, North Carolina, United States of America
| | - Donna M. Wilcock
- University of Kentucky Sanders-Brown Center on Aging, Department of Physiology, Lexington, Kentucky, United States of America
- * E-mail:
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Abstract
The aim of this study was to provide data to aid decision making regarding lithium use during lactation. Three women treated with lithium for bipolar disorder during pregnancy and lactation and their four infants provided lithium levels at 1 month postpartum. Infant levels ranged from 10% to 17% of maternal levels. Two infants experienced early feeding problems which were overcome with breastfeeding education and support. Women taking lithium can be supported to breastfeed, and their infants should be followed closely until breastfeeding is well established.
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Affiliation(s)
- Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Yazıcı O, Cakır S. [Unipolar mania: a distinct entity or characteristic of manic preponderance?]. Turk Psikiyatri Derg 2012; 23:201-205. [PMID: 22949290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE It has been reported that fewer patients with unipolar mania respond to lithium prophylaxis as do those with classical bipolar disorder. This study aimed to determine if the difference to response to lithium is related to unipolar mania or to a high preponderance of mania during the course of bipolarity. MATERIALS AND METHODS The study included bipolar-I patients (according to DSM-IV criteria) that had a ≥ 2-year history of either lithium or valproate prophylaxis as monotherapy. The response rate in the patients with unipolar mania and classical bipolar disorder were compared. Then, the response rate to lithium in all the patients with a manic episode rate <50% and >50%, and <80% and >80% during their course were compared. Finally, the above comparisons were repeated, excluding the patients with unipolar mania. RESULTS The study included 121 bipolar-I patients (34 unipolar mania and 87 classical bipolar disorder). The response rate to lithium prophylaxis was significantly lower in the unipolar mania group than that in the bipolar group, whereas, the response rate to valproate prophylaxis was similar in both groups. Additionally, significantly fewer patients with a manic episode rate >80% during their course responded to lithium, followed by those with a manic episode rate >50%; however, these differences disappeared when the unipolar mania group was excluded from the comparison. CONCLUSION Fewer patients with unipolar mania responded to lithium prophylaxis than those with classical bipolar disorder, which appeared to be related to unipolar mania, rather than to a high manic predominance during the disease course. On the other hand, response to valproate prophylaxis was similar in the unipolar mania and classical bipolar disorder groups.
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Wada K. [Mood stabilizers]. Nihon Rinsho 2012; 70:58-62. [PMID: 22413493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mood stabilizers available in Japan include lithium, valproate, carbamazepine, and lamotrigine. These are prescribed for manic or hypomanic episodes of bipolar disorder, organic mania, and drug-induced mania. Careful dose titration is needed in consideration for serum drug level and clinical symptoms. Lithium frequently develops neurological toxicity because of its narrow therapeutic serum level. Valproate has the most favorable adverse effect profile among mood stabilizers, but gastrointestinal symptoms and weight gain can appear with a dose dependent fashion. Hyperammonemia is occasionally induced early after initiation of valproate and tends to be overlooked. Carbamazepine sometimes develops liver dysfunction and skin disorders associated with allergic mechanisms. Lamotrigine should be slowly titrated to avoid severe skin disorders such as Stevens-Johnson syndrome.
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Affiliation(s)
- Ken Wada
- Department of Psychiatry, Hiroshima City Hospital
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Kelley C. My spiritual journey. Narrat Inq Bioeth 2011; 1:13-15. [PMID: 24406521 DOI: 10.1353/nib.2011.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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da Silveira VG, de Paula Cognato G, Müller AP, Figueiró F, Bonan CD, Perry MLS, Battastini AMO. Effect of ketogenic diet on nucleotide hydrolysis and hepatic enzymes in blood serum of rats in a lithium-pilocarpine-induced status epilepticus. Metab Brain Dis 2010; 25:211-7. [PMID: 20443057 DOI: 10.1007/s11011-010-9198-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
Abstract
The ketogenic diet (KD) is a high-fat and low-carbohydrate diet, used for treating refractory epilepsy in children. We have previously shown alterations in nucleotidase activities from the central nervous system and blood serum of rats submitted to different models of epilepsy. In this study we investigated the effect of KD on nucleotidase activities in the blood serum, as well if KD has any influence in the activity of liver enzymes such as alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase activities in Wistar rats submitted to the lithium-pilocarpine model of epilepsy. At 21 days of age, rats received an injection of lithium chloride and, 18-19 h later, they received an injection of pilocarpine hydrochloride for status epilepticus induction. The results reported herein show that seizures induced by lithium-pilocarpine elicit a significant increase in ATP hydrolysis and alkaline phosphatase activity, as well as a decrease in ADP hydrolysis and aspartate aminotransferase activity. The KD is a rigorous regimen that can be associated with hepatic damage, as shown herein by the elevated activities of liver enzymes and 5'-nucleotidase in blood serum. Further studies are necessary to investigate the mechanism of inhibition of lithium on nucleotidases in blood serum.
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Affiliation(s)
- Vanessa Gass da Silveira
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Anexo, Porto Alegre, Brazil
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Lo V, Maggio L. Clinical inquiries. What's best when a patient doesn't respond to the maximum dose of an antidepressant? J Fam Pract 2010; 59:173-175. [PMID: 20230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
First, consider possible causes of the inadequate response to an antidepressant, then weigh treatment options in light of the characteristics of the individual patient and therapy. When managing a patient with nonpsychotic depression and inadequate response to the maximum dose of a single antidepressant, the physician should first identify factors that may contribute to the poor response, such as suboptimal dosage resulting from nonadherence, inadequate duration of therapy, and comorbid medical and psychiatric conditions. The literature supports several treatment alternatives, including augmentation with cognitive therapy, switch therapy, and combination-augmentation therapy; not enough studies exist to recommend the best treatment. All options reviewed produced a 20% to 50% remission rate. Physicians should consider the patient's clinical history and preferences, along with drug toxicity, potential drug interactions, and cost when making treatment decisions.
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Affiliation(s)
- Vincent Lo
- San Joaquin General Hospital Family Medicine Residency Program, French Camp, CA, USA
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Terao T, Goto S, Hoaki N, Wang Y. [Reconsideration of bipolar disorder and lithium therapy]. Seishin Shinkeigaku Zasshi 2010; 112:274-279. [PMID: 20458814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
The administration-time-dependent aspects of the drug interaction between lithium and morphine-induced analgesia were studied using the mouse hot-plate test at six different times of day, each scheduled at 4 h intervals. Lithium treatment alone, in doses of 1 to 10 mmol/kg administered intraperitoneally (i.p.) did not significantly alter test latencies compared to the corresponding clock-time in saline-injected controls. Basal pain sensitivity and morphine-induced antinociceptive activity displayed significant circadian rhythms as assessed by the hot-plate response latencies, with higher values occurring during the nocturnal activity than during the daytime rest span. Acute administration of lithium, in a dose of 3 mmol/kg, 30 min prior to morphine dosing did not influence morphine-induced analgesia compared to all the clock-time test-matched morphine groups, except the 9 HALO (Hours After Lights On) one. There was a prominent potentiation of the morphine-induced antinociception at this biological time during combined drug treatment. The latter finding demonstrates that administration-time-dependent differences in drug-drug interactions need to be considered in both experimental designs and clinical settings.
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Affiliation(s)
- Elif Hilal Karakucuk
- Department of Medical Pharmacology, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey
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40
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Abstract
Drugs are easy to prescribe, and if a manic-depressive patient is not helped by one prophylactically administered drug, physicians may be apt as a first reaction to prescribe another drug, especially now that alternatives to lithium have become available. This may or may not be the appropriate course of action. Often nonpharmacological factors determine whether patients consume their medicine and whether they respond to it, and concern about patient selection, patient characteristics, treatment execution, patient and therapist attitudes, treatment organization, and supplementary psychological support may more profitably serve to ensure that manic-depressive patients obtain help from prophylactic drug treatment. Only by employing a treatment approach which integrates pharmacological and nonpharmacological measures can optimal results be obtained.
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Affiliation(s)
- M Schou
- Psychopharmacology Research Unit, Aarhus University Institute of Psychiatry, Risskov, Denmark
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41
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Abstract
Lithium treatment is a proven and effective prophylactic treatment of bipolar affective disorders. To day patients receive their lithium in one or two daily doses, and the dosage level in the individual patient is adjusted to the lowest possible level in order to reduce side effects. In the present article we suggest an alternative treatment strategy also aiming at reducing side effects but not involving the slow process of finding the lowest possible effective lithium dose. We suggest prophylaxis may be obtained by giving lithium every second day in a dose producing 12 hour serum lithium concentrations between 0.6 and 0.9 mM, and leading to very low lithium concentrations every second day. This treatment schedule is at present being tested in the clinic.
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Affiliation(s)
- P Plenge
- Psychochemistry Institute, Rigshospitalet, Copenhagen, Denmark
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Ratanajamit C, Soorapan S, Doang-ngern T, Waenwaisart W, Suwanchavalit L, Suwansiri S, Jantasaro S, Yanate I. Appropriateness of therapeutic drug monitoring for lithium. J Med Assoc Thai 2006; 89:1954-60. [PMID: 17205880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Evaluate the appropriateness of therapeutic drug monitoring (TDM) for lithium. MATERIAL AND METHOD A retrospective chart review of all patients who received lithium for treatment of psychiatric disorders between January 2004 and October 2005 was done. The present study was investigated in a psychiatric hospital in Thailand Based on detailed chart review, the appropriateness of TDM utilization comprised of three aspects, i.e., the indication of TDM request, the time of blood sample taking in relation to the medication process, and the clinical applications of the reported serum lithium levels, were evaluated. The Morecambe Bay Shared Care Guideline 2003 was modified and used as criteria for evaluation. Altogether 91 serum lithium samples were measured among 60 patients. RESULT In 66 (72.5%) of requests, clear indications for lithium TDM were recorded i.e., initiation therapy 41.8%, suspected toxicity 15.4%, patient compliance assessment 5.5%, after regimen changes 5.5%, and therapeutic failure 4.4%. Routine tests without specified indications were found in the remainder (27.5%), all were in-patients, which pointed to potentially redundant use. The time of sample taking was recorded in 37 (40.6%) of blood samples, all were taken from in-patients, after steady state had been reached. These data for out-patients were not recorded, except one noted that blood sample was drawn after the patient had not received lithium for four days. Serum lithium levels were reported in 83 (91.2%) samples. Of these, 37 (44.6%) were out of therapeutic range, and only 12 required dosage alterations. The evaluation demonstrated somewhat inappropriate use of reported lithium levels. Dose changes were done in some patients who required dosage adjustment. Among 14 toxicity-suspected patients, nine actually had serum lithium levels exceeding the therapeutic range. Of these, only one patient was subsequently switched to a reduced dose, three patients were discontinued while five patients were prescribed the pre-TDM doses. Similarly, in five toxicity-suspected patients whose serum lithium levels were below therapeutic range, lithium was discontinued in three patients and no dosage alteration, which was considerably acceptable, in two patients. The doses were increased in three out offour inadequately controlled patients whose serum lithium was lower than the therapeutic range. Overall, in only 33 (36.3%) requests was TDM performed appropriately according to the indication, sampling time and subsequent dose adjustment. CONCLUSION The findings indicate the need to improve the utilization of TDM for lithium. Education for hospital personnel on appropriateness of serum sample collection, interpretation, and proper use of serum drug levels is encouraged. Development of a request form containing essential data, such as indication for TDM, current drug dosing regimen, time of last dose, patient compliance, test results and interpretations and clinical decision made, can help optimize TDM use and reduce unnecessary costs.
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Affiliation(s)
- Chaveewan Ratanajamit
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Engel T, Goñi-Oliver P, Lucas JJ, Avila J, Hernández F. Chronic lithium administration to FTDP-17 tau and GSK-3beta overexpressing mice prevents tau hyperphosphorylation and neurofibrillary tangle formation, but pre-formed neurofibrillary tangles do not revert. J Neurochem 2006; 99:1445-55. [PMID: 17059563 DOI: 10.1111/j.1471-4159.2006.04139.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Glycogen synthase kinase-3 (GSK-3) has been proposed as the main kinase able to aberrantly phosphorylate tau in Alzheimer's disease (AD) and related tauopathies, raising the possibility of designing novel therapeutic interventions for AD based on GSK-3 inhibition. Lithium, a widely used drug for affective disorders, inhibits GSK-3 at therapeutically relevant concentrations. Therefore, it was of great interest to test the possible protective effects of lithium in an AD animal model based on GSK-3 overexpression. We had previously generated a double transgenic model, overexpressing GSK-3beta in a conditional manner, using the Tet-off system and tau protein carrying a triple FTDP-17 (frontotemporal dementia and parkinsonism linked to chromosome 17) mutation. This transgenic line shows tau hyperphosphorylation in hippocampal neurones accompanied by neurofibrillary tangles (NFTs). We used this transgenic model to address two issues: first, whether chronic lithium treatment is able to prevent the formation of aberrant tau aggregates that result from the overexpression of FTDP-17 tau and GSK-3beta; second, whether lithium is able to change back already formed NFTs in aged animals. Our data suggest that progression of the tauopathy can be prevented by administration of lithium when the first signs of neuropathology appear. Furthermore, it is still possible to partially reverse tau pathology in advanced stages of the disease, although NFT-like structures cannot be changed. The same results were obtained after shut-down of GSK-3beta overexpression, supporting the possibility that GSK-3 inhibition is not sufficient to reverse NFT-like aggregates.
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Affiliation(s)
- Tobias Engel
- Centro de Biología Molecular 'Severo Ochoa', Universidad Autónoma de Madrid, Madrid, Spain
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Abstract
Lithium augmentation refers to the addition of lithium to an antidepressant in the acute treatment phase of patients with depressive episodes who have failed to respond satisfactorily to treatment with antidepressant monotherapy. This article reviews the clinical evidence and hypotheses on the mode of action of lithium augmentation. For this purpose, studies were identified by searching Medline and by scanning the references of published reviews and standard textbooks. With regard to efficacy, 28 prospective studies (with a total of 838 depressed patients) were identified. The majority of randomized controlled trials has demonstrated substantial efficacy of lithium augmentation. A recent meta-analysis including only double-blind, placebo-controlled trials (N = 9) provided firm evidence that lithium augmentation has a statistically significant effect on response rate compared to placebo, and showed that lithium augmentation should be administered for at least 2 weeks to allow assessment of the patient's response. A recent double-blind, placebo-controlled trial revealed that responders to lithium augmentation should be maintained on the lithium-antidepressant combination for a minimum of 12 months. From animal studies there is robust evidence that lithium augmentation increases serotonin (5-HT) neurotransmission, possibly through a synergistic action of lithium and the antidepressant on brain 5-HT pathways. Neuroendocrine studies in humans on the effects of lithium augmentation on the HPA system showed an unexpected and marked increase in the ACTH and cortisol response in the combined dexamethasone/CRH test. These results are in contrast to the established decline of HPA system activity during treatment with antidepressants. In conclusion, lithium is the foremost and most well-documented augmentation strategy in refractory depression. In international treatment guidelines and algorithms, lithium augmentation is considered a first-line treatment strategy for patients with a major depressive episode who do not adequately respond to standard antidepressant treatment.
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Affiliation(s)
- Tom Bschor
- Department of Psychiatry and Psychotherapy, Jewish Hospital Berlin, Heinz-Galinski-Str. 1, D-13347 Berlin, Germany.
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Youngs RM, Chu MS, Meloni EG, Naydenov A, Carlezon WA, Konradi C. Lithium administration to preadolescent rats causes long-lasting increases in anxiety-like behavior and has molecular consequences. J Neurosci 2006; 26:6031-9. [PMID: 16738246 PMCID: PMC4205587 DOI: 10.1523/jneurosci.0580-06.2006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lithium (Li) is frequently used in the treatment of bipolar disorder (BPD), a debilitating condition that is increasingly diagnosed in children and adolescents. Because the symptoms of BPD in children are different from the typical symptoms in adulthood and have significant overlap with other childhood psychiatric disorders, this disorder is notoriously difficult to diagnose. This raises the possibility that some children not affected by BPD are treated with Li during key periods of brain development. The objective of this investigation was to examine the long-term effects of Li on the developing brain via a series of behavioral and molecular studies in rats. Rat pups were reared on Li chow for 3 weeks. Parallel groups were tested while on Li chow or 2 and 6 weeks after discontinuation of treatment. We found increased measures of anxiety-like behavior at all times tested. Gene microarray studies of the amygdala revealed that Li affected the expression of gene transcripts of the synapse and the cytoskeleton, suggesting that the treatment induced synaptic adjustments. Our study indicates that Li can alter the trajectory of brain development. Although the effects of Li on the normal brain seems unfavorable, effects on the abnormal brain cannot be determined from these studies alone and may well be therapeutic. Our results indicate that Li administration to the normal brain has the potential for lasting adverse effects.
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Lee DK, Nathan Grantham R, Trachte AL, Mannion JD, Wilson CL. Activation of the canonical Wnt/beta-catenin pathway enhances monocyte adhesion to endothelial cells. Biochem Biophys Res Commun 2006; 347:109-16. [PMID: 16815294 DOI: 10.1016/j.bbrc.2006.06.082] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 06/11/2006] [Indexed: 11/16/2022]
Abstract
Monocyte adhesion to vascular endothelium has been reported to be one of the early processes in the development of atherosclerosis. In an attempt to develop strategies to prevent or delay atherosclerosis progression, we analyzed effects of the Wnt/beta-catenin signaling pathway on monocyte adhesion to various human endothelial cells. Adhesion of fluorescein-labeled monocytes to various human endothelial cells was analyzed under a fluorescent microscope. Unlike sodium chloride, lithium chloride enhanced monocyte adhesion to endothelial cells in a dose-dependent manner. We further demonstrated that inhibitors for glycogen synthase kinase (GSK)-3beta or proteosome enhanced monocyte-endothelial cell adhesion. Results of semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR) indicated that activation of Wnt/beta-catenin pathway did not change expression levels of mRNA for adhesion molecules. In conclusion, the canonical Wnt/beta-catenin pathway enhanced monocyte-endothelial cell adhesion without changing expression levels of adhesion molecules.
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Affiliation(s)
- Dong Kun Lee
- Cardiovascular Care Center, Comanche County Memorial Hospital, Lawton, OK 73502, USA.
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Frey BN, Andreazza AC, Ceresér KMM, Martins MR, Valvassori SS, Réus GZ, Quevedo J, Kapczinski F. Effects of mood stabilizers on hippocampus BDNF levels in an animal model of mania. Life Sci 2006; 79:281-6. [PMID: 16460767 DOI: 10.1016/j.lfs.2006.01.002] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 11/29/2005] [Accepted: 01/04/2006] [Indexed: 11/24/2022]
Abstract
There is an emerging body of data suggesting that mood disorders are associated with decreased brain-derived neurotrophic factor (BDNF). The present study aims to investigate the effects of the mood stabilizers lithium (Li) and valproate (VPT) in an animal model of bipolar disorder. In the first experiment (acute treatment), rats were administered D-amphetamine (AMPH) or saline for 14 days, and then between day 8 and 14, rats were treated with either Li, VPT or saline. In the second experiment (maintenance treatment), rats were pretreated with Li, VPT or saline, and then between day 8 and 14, rats were administered AMPH or saline. In both experiments, locomotor activity was measured using the open-field test and BDNF levels were measured in rat hippocampus by sandwich-ELISA. Li and VPT reversed AMPH-induced behavioral effects in the open-field test in both experiments. In the first experiment, Li increased BDNF levels in rat hippocampus. In the second experiment, AMPH decreased BDNF levels and Li and VPT increased BDNF levels in rat hippocampus. Our results suggest that the present model fulfills adequate face, construct and predictive validity as an animal model of mania.
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Affiliation(s)
- Benício N Frey
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600/Anexo, Zip code: 90035-003, Porto Alegre, RS, Brazil
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Tomasiewicz HC, Mague SD, Cohen BM, Carlezon WA. Behavioral effects of short-term administration of lithium and valproic acid in rats. Brain Res 2006; 1093:83-94. [PMID: 16687130 DOI: 10.1016/j.brainres.2006.03.102] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 03/13/2006] [Accepted: 03/14/2006] [Indexed: 11/18/2022]
Abstract
Lithium and valproic acid are mood-stabilizing agents that are often used to manage the episodes of mania and depression that characterize bipolar disorder. These agents develop clinical efficacy with chronic treatment, but the neurobiological actions that contribute to their therapeutic effects remain unclear. The present work was designed to study and compare various behavioral effects of short-term administration of lithium chloride (LiCl) and valproic acid (VPA) in rats. Specifically, we examined the effects of acute and sub-acute injections of these agents on locomotor activity, behavior in the forced swim test (FST), and intracranial self-stimulation (ICSS) thresholds. Locomotor activity studies were used to identify the range of doses with gross behavioral effects in rats. At doses below those that suppressed activity (total distance traveled, in cm) in 1-h test sessions, LiCl had prodepressant-like effects: it increased immobility in the FST, an effect opposite to that typically seen with standard antidepressants, and it increased ICSS thresholds, an effect similar to that typically seen during withdrawal from drugs of abuse. In contrast, VPA had no effects in the FST or on ICSS thresholds. This work identifies potentially important characteristics that distinguish the drugs at doses below those that produce non-specific behavioral effects, and thus serves as a basis for designing and interpreting studies of long-term treatment.
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Affiliation(s)
- Hilarie C Tomasiewicz
- Behavioral Genetics Laboratory, Department of Psychiatry, Harvard Medical School, McLean Hospital, MRC 217 115 Mill St., Belmont, MA 02478, USA
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Risperidone: new indication. Behavioural disorders in children with autism or mental disabilities: no progress. Prescrire Int 2006; 15:43-5. [PMID: 16602211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
(1) Sedative drugs are one option when autistic or mentally disabled children have behavioural disorders that place them (or other people) in physical danger. Among the classic neuroleptics, haloperidol is the drug with the best-documented efficacy and safety. Placebo-controlled trials have also shown lithium to be effective for this use. (2) Clinical evaluation of risperidone in children with mental disabilities includes 3 placebo-controlled double-blind trials, 2 of which involved 118 and 110 children aged from 5 to 12 years who were treated for 6 weeks. All 3 trials showed a partial behavioural improvement in about 75% of children receiving risperidone, versus about 30% of children in the placebo groups. (3) Clinical evaluation of risperidone in autistic children includes 2 placebo-controlled double-blind trials involving 110 and 79 children who were treated for 8 weeks. One of these studies has been published in detail: 69% of children partially improved with risperidone, versus 12% of the children on placebo. (4) Given the absence of clinical trials comparing risperidone with haloperidol or lithium, there is no evidence that risperidone is more effective than these other treatments. (5) The principal adverse events observed in short-term trials of risperidone were drowsiness (affecting about 50% of children), weight gain (about 1.2 kg per month during the first months of treatment), and hyperprolactinaemia (affecting about 12% of children). Extrapyramidal disorders were infrequent during short-term trials, but their incidence reached about 25% after a year of risperidone treatment. (6) The impact of long-term risperidone therapy on growth and mental development is not known. (7) In France treatment is about 7 times more expensive with risperidone than with haloperidol. (8) In practice, the risk-benefit balance of risperidone in the treatment of autistic or mentally disabled children with behavioural disorders is no better overall than that of older products such as haloperidol and lithium, which, in the absence of anything better, remain the standard drugs.
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