The lithium It can be used to treat depression and bipolar disorder thanks to its mood stabilizing properties. It is a medicine that is normally used to treat and prevent the typical episodes of mania that are experienced in bipolar disorder..
Lithium is a drug that is one of the drugs known as mood stabilizers; its mechanism of action consists of stabilizing the mood, that is, ensuring that the affect is neither excessively high nor excessively low.
However, the mechanism of action of lithium is not fully understood. It is believed that this works by modifying second messenger systems.
In fact, the most strongly held hypothesis today is that lithium alters G proteins and their ability to send signals within the cell once the receptor is occupied by the neurotransmitter..
Explained in a less technical way, this would mean that lithium would be able to stabilize mood through indirect mechanisms..
That is, lithium could alter mental functioning and return it to a stabilized state by modifying the actions of the proteins that determine the functioning of neurons..
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Lithium is not considered a first-line medicine to treat depression due to the existence of more effective drugs to reduce the symptoms that occur in this disease.
Thus, the most commonly used drugs to treat depressive episodes of depression are heterocyclic antidepressants (such as impipramine), SSRI antidepressants (such as paroxetine) and newer antidepressants (such as mirtazapine).
This fact could be explained because antidepressants have a more direct effect on elevating mood. While lithium allows it to stabilize (increase or reduce) the mood, antidepressants manage to raise it directly.
Thus, in depressions the use of lithium is reduced to the combination with an antidepressant in the maintenance phases to prevent relapses and recurrences..
The same does not happen in the treatment of depressive episodes of bipolar disorder.
In these episodes, although the symptoms may be very similar to those shown during depression, the use of lithium acquires much more importance and becomes a vital medicine for its treatment..
This effect is explained through the characteristics of bipolar disorder.
As we have said before, bipolar disorder is characterized by the presentation of depressive episodes which are followed by the appearance of manic episodes..
Thus, when a depressive episode appears, it is very likely that a manic episode will appear later..
As a general rule, the use of antidepressants is discouraged during these phases since they can raise the mood quickly and cause the appearance of a manic episode immediately.
In these cases, lithium becomes the drug of first choice, since this, although it will raise the mood in a slower and less effective way than the antidepressant, will prevent the appearance of a manic episode.
The pharmacological treatment of bipolar disorder continues to be a challenge for psychiatrists today, since each phase of the disease usually requires a different therapeutic approach.
However, during the last 50 years there have been certain changes in the trends of use of the different drugs available to treat this type of psychopathological alteration.
In this sense, lithium has been, and continues to be, the drug par excellence for bipolar disorder. In fact, in the 1950s and 1960s it was already accepted in Europe and continues to be maintained today..
Recently, the Collegiate Medical Organization and the Ministry of Health and Consumption have prepared an action manual in the case of mania that collects the evidence in favor of the use of lithium in these pathologies.
Specifically, a study has shown strong evidence for the use of lithium in acute mania, that is, in those cases in which manic symptoms are expressed autonomously.
The study demonstrated how in randomized controlled trials of this type of psychopathology, lithium achieved a good pharmacological response in practically all cases.
However, in this same study, lithium only achieved limited evidence on its effectiveness in treating cases of mixed mania, that is, to intervene in those episodes that present depressive symptoms and manic symptoms simultaneously.
In these cases, other drugs such as valporate or cabramazepine demonstrated greater treatment efficacy..
Lithium has been shown to be more effective in the treatment of manic episodes than in the treatment of mixed episodes, which is why the diagnosis of these characteristics of bipolar disorder are very important when specifying the treatment plan.
With regard to the hypomanic phases, lithium has been shown to be an effective drug to reduce symptoms, stabilize mood and restore optimal function.
This fact was confirmed by a retrospective study carried out by Tono on the efficacy of lithium in reversing hypomanic phases in a total of 129 people with type II bipolar disorder..
In addition, in this same study, the effects of lithium to treat manic symptoms were studied in a total of 188 individuals diagnosed with type I bipolar disorder..
In this second review by Tono, the efficacy of lithium was found to be more effective in treating hyperthymic symptoms (manic episodes and hypomanic episodes) than in treating hypothymic symptoms (depressive episodes)..
Finally, it should be noted that other types of drugs are often added to lithium treatment for bipolar disorder.
Multiple studies have shown that certain antipsychotics interact well with lithium and increase the potential for treatment to reverse the symptoms of bipolar disorder..
More specifically, in the manual prepared by the Collegiate Medical Organization and the Ministry of Health and Consumption, it was found that Haloperidol, Risperidone, Olanzapine, Quetiapine and Arpiprazole are optimal medications to accompany a treatment with lithium.
Finally, it should be noted that, as demonstrated by Goodwin and Jamison in 1990, lithium is an appropriate drug for the maintenance treatment of bipolar disorder since it reduces the frequency, duration and intensity of manic, hypomanic and depressive episodes.
From all this we can draw the following conclusions about the efficacy of lithium for bipolar disorder:
When we relate depression with bipolar disorder, we can present the following conclusions.
It is not surprising that a drug that manages to eutimize the state of mind such as lithium, becomes an appropriate drug to treat this type of psychological disturbances.
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