Lithium: The Forgotten Wonderdrug

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Potential Toxicity of Long Term <strong>Lithium</strong> Use • Long term treatment with lithium can induce functional and/or structural disturbances in the kidneys – Patients who had received lithium salts for a mean period of 17.7 years showed mean reduction in creatinine clearance of 2.23 ml/min/year – In 7 patients treated a mean of 22 years, progression towards terminal kidney failure required periodical dialysis Presne C, Fakhouri F, Kenouch S, Stengel B, Kreis H, Grunfeld JP. Progressive renal failure caused by lithium nephropathy. Presse Med. 2002 May 25;31(18):828-33.
Potential Toxicity of Long Term <strong>Lithium</strong> Use • Thyroid function was investigated in 100 manicdepressive patients – Goiter was more common in patients treated with lithium for 1-5 years (44%) and more than 10 years (50%) than in patients who never received lithium (16%) – Hypothyroidism was found in 21% of patients treated with lithium for more than 10 years Perrild H, Hegedus L, Baastrup PC, Kayser L, Kastberg S. Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment. Am J Psychiatry. 1990 Nov;147(11):1518-21.
Page 1 and 2: Lithium: The Forgotten Wonderdrug W
Page 3: What Is Lithium
Page 7 and 8: History • 1880s to early 1900s li
Page 9 and 10: Psychiatric Uses For Lithium • An
Page 11 and 12: Advantages of Lithium • Well esta
Page 13 and 14: Decline In Lithium Use
Page 15 and 16: Trend in Veterans Affairs Medical C
Page 17 and 18: Lithium Therapy And Suicide Risk In
Page 19 and 20: Suicide Risk in Mood Disorders •
Page 21 and 22: Overall Rates • Suicides and atte
Page 23 and 24: Rates of Suicide Attempts • Suici
Page 25 and 26: Risk Reduction in Diagnostic Subtyp
Page 27 and 28: Other Important Risk Factors in Sui
Page 29 and 30: Limitations of Evidence • Lack of
Page 31 and 32: Rationale For Long Term Treatment W
Page 33 and 34: Relapse in Bipolar Disorder • Des
Page 35 and 36: Episode Recurrence in Bipolar I Dis
Page 37 and 38: Episode Recurrence in Bipolar I Dis
Page 39 and 40: Reduction of Episode Recurrence •
Page 41: Risk vs Benefit Of Lithium Maintena
Page 45 and 46: Reducing Risk, Increasing Benefit:
Page 47 and 48: Initiating and Monitoring Lithium T
Page 49 and 50: Initiating Lithium • Prior to ini
Page 51 and 52: Blood Monitoring • Lithium can be
Page 53 and 54: Therapeutic Levels • Upper end: 1
Page 55 and 56: Lithium Discontinuation
Page 57 and 58: Reduced Morbidity After Gradual Dis
Page 59 and 60: Lithium Discontinuation and Subsequ
Page 61 and 62: APA Treatment Guidelines For Bipola
Page 63 and 64: Bipolar Depression • First line t
Page 65 and 66: Maintenance “The medications with

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