Podcast Summary
Lithium: Underutilized Mood Stabilizer in US Due to Fear of Toxicity: Lithium is an effective mood stabilizer for bipolar spectrum disorders, reducing mood cycling, mania, depression, and suicide risk. Despite its narrow therapeutic index, it's crucial for augmenting major depression and decreasing violent behavior.
Lithium, a mood stabilizer with a narrow therapeutic index, is underutilized in the US due to fear of its toxicity. Despite this, lithium is effective in treating bipolar spectrum disorders as a robust mood stabilizer, effective against mania and depression, and provides prophylaxis against mood cycling. It is also the best-tested drug for augmenting major depression that does not respond adequately to antidepressants alone. Lithium's anti-suicidal effect, independent of its mood effects, makes it essential in reducing suicide risk in individuals with mood disorders by almost fivefold. Its effectiveness in decreasing violent behavior is true for both mentally ill individuals and the general population. In Europe, half of individuals with bipolar use lithium, and the US should consider overcoming fear and increasing its use.
Lithium's Role in Preventing Violence and Suicide: Lithium, a mood stabilizer, linked to lower rates of violence, suicide, and homicide. Effective in treating manic episodes, bipolar depression, and preventing recurrence. Promising results in reducing suicidality. Most effective mood stabilizer for classic type 1 bipolar illness.
Lithium, a commonly used mood stabilizer, has been linked to lower rates of violence, suicide, and homicide in areas with natural water supplies containing trace amounts of lithium. This finding has led to the consideration of adding very low doses of lithium as a nutritional additive to foods by the European medication council. Lithium is effective in treating both manic episodes and preventing them, as well as being effective in treating bipolar depression, which is notoriously difficult to treat. Lithium's unique properties include its use as a weak stimulant of colony stimulating factor in certain individuals taking clozapine. Despite its effectiveness, lithium is less effective than other mood stabilizers like valproic acid for rapid cycling bipolar illness or for type 2 bipolar illness. Lithium's effect on suicidality and depression differs from its effect on bipolar illness, and the plasma concentrations for treating suicidality don't correlate well with efficacy. Lithium is the most well-rounded mood stabilizer, being effective against both mood elevation and depression and serving as a prophylactic measure. It is the most effective mood stabilizer for classic type 1 bipolar illness, but less effective for other forms. Lithium's use in depression has shown promising results in reducing suicidality, leading to the shutdown of a multisite study due to its effectiveness.
Lithium's Effect on Impulsive Violence and Mood Disorders: Lithium, effective in reducing impulsive violent behavior, calms limbic response, improves prefrontal inhibition, optimal dosage around 0.6mmol/L, benefits extend to serotonin receptors, gsk 3 Beta inhibition, neurotrophic factors, antidepressant, antimanic, neuroprotective effects.
Lithium, a commonly used medication for mood disorders, has been found to be effective in reducing impulsive violent behavior by calming down the limbic response and improving prefrontal inhibition. The optimal dosage for this effect is around 0.6 millimoles per liter in therapeutic use, but lower doses, such as 3 milligrams per day, may be sufficient for the general population due to their lesser degree of pathology. Lithium's benefits extend beyond the limbic system, as it also acts on serotonin receptors, inhibits gsk 3 Beta, and promotes neurotrophic factors like BDNF and BCL 2. These mechanisms contribute to its antidepressant, antimanic, and neuroprotective effects. The exact way lithium exerts its benefits is not fully understood, but its wide range of actions on various brain circuits and second messengers is believed to be critical.
Medications with neurotrophic effects promote brain growth and connection: Some psychiatric medications, like lithium and certain antipsychotics, promote brain growth and connection, improving cognition and behavior in neurocognitive disorders and depression, while also regrowing lost neuronal connections.
Certain medications, such as lithium and some second-generation antipsychotics like aripiprazole and Olanzapine, have neurotrophic effects, meaning they promote growth and connection in the brain. These medications have shown promise in improving cognition and behavior in individuals with neurocognitive disorders like Alzheimer's disease, although they may not reverse the overall progression of the condition. This is unique among psychiatric medications and can be seen as a "miracle growth" for the brain. Other medications, such as haloperidol and first-generation antipsychotics, as well as antidepressants, also have neurotrophic effects. The overall impact of increasing neurotrophic factors in the brain is not yet fully understood, but it is known to lead to thickening of the cortex in successfully treated depression. During depression, there is a loss of dendritic arborization and connection among neurons, which regrow as the person recovers. These medications, such as lithium and antidepressants, seem to promote this regrowth. In severe mental health conditions, psychotherapy may not be enough, and these psychopharmacological options are essential.
Hand in hand: Psychopharmacology and psychotherapy: Effective mental health treatment combines medication and therapy. Lithium, a commonly used med, requires careful monitoring for safety and effectiveness. Building trust through therapeutic alliance boosts adherence and treatment success.
Psychopharmacology and psychotherapy work hand in hand, especially for severe mental illnesses. Psychopharmacology aims to improve the functionality of the brain, making individuals more responsive to psychosocial treatments. Medications like lithium are tools that require careful monitoring, including checking thyroid status and renal function before starting treatment. The toxicity of lithium is often due to unrelated medical issues, and ideal levels are crucial to ensure safety and effectiveness. Developing a therapeutic alliance with patients is essential to encourage medication adherence and trust in the treatment process.
Lithium Loading: A Rapid Method for Reaching Therapeutic Levels: Lithium loading is a method to quickly reach therapeutic levels for those requiring rapid mood stabilization. It involves an initial dose based on weight, followed by blood tests to determine steady state level after five days. Minimal side effects and no dropouts were reported.
Lithium, a common medication used to treat bipolar illness, can be introduced to the body through a method called lithium loading. This approach aims to quickly reach therapeutic levels for those in need of rapid mood stabilization. During this process, a person is given an initial dose of lithium based on their weight, followed by blood tests to determine the steady state level after five days. Side effects during this study were minimal, and no participants dropped out. This method is particularly useful when a gradual increase in lithium dosage over several weeks is not desired. Keep in mind that extended release lithium is harder on the kidneys, so it should only be used for the first day of loading. Additionally, blood tests are typically taken 12 hours after the last dose, which is a convention from earlier studies.
Follow standardized post-dose testing timeframes for accurate drug comparison: Regardless of a drug's half-life, follow 12-hour post-dose tests for accurate comparison to established reference ranges. Check lithium and renal/thyroid function regularly, especially after starting or adjusting doses.
For accurate comparison of drug levels with established reference ranges, it's essential to follow standardized post-dose testing timeframes, such as 12 hours, regardless of the drug's half-life. This is because most studies determining optimal therapeutic ranges have been conducted based on 12-hour post-dose tests. For instance, lithium, which has a brain half-life between 24 and 30 hours, requires a waiting period of 4 days for accurate blood level measurement. The time to reach steady state or wash out for drugs following first-order kinetics is typically 5 half-lives. However, it's crucial to measure blood levels rather than relying on doses alone for effective treatment evaluation. In general, lithium and renal function, as well as thyroid function, should be checked weekly for the first 4 weeks, then monthly for the next 2 months, quarterly for a year, and every 6 to 12 months thereafter. In the case of marathon runners or individuals engaging in strenuous physical activity, special caution is necessary to avoid dehydration, as it can lead to increased lithium levels and potential toxicity.
Monitoring lithium levels during low-salt diets and heavy sweating: Lithium, a mood stabilizer, requires careful monitoring for hydration and sodium levels, especially during low-salt diets or heavy sweating, to prevent toxicity and potential side effects.
Lithium, a common mood stabilizer, requires careful monitoring when it comes to hydration and sodium levels. The kidney can't distinguish between lithium and sodium, so if someone is on a low-salt diet or sweating profusely, they risk retaining too much lithium. This can lead to increased lithium levels in the body, potentially causing side effects. During pregnancy, the use of lithium carries a risk of Ebstein's anomaly, a heart defect, during the first five weeks of gestation. However, after the heart has formed, lithium no longer poses a risk. Lithium is often the mood stabilizer of choice during the second and third trimesters due to the teratogenic risks associated with other common mood stabilizers. Lithium enters breast milk in very low concentrations and has not been shown to have any adverse effects on infants. Despite this, many guidelines caution against breastfeeding while taking lithium, an abundance of caution that may not be necessary.
Intestinal surgeries impact lithium absorption and dosing: Individuals with reduced absorptive surfaces due to intestinal surgeries may struggle to absorb lithium fully, requiring careful monitoring and potentially adjustments to treatment plans.
For individuals who have undergone significant intestinal surgeries, such as ruptures or removal of large parts of their absorptive surface, the absorption and dosing of lithium, a commonly prescribed medication for mental health conditions, may be affected. Lithium, especially its immediate-release formulation, is well-absorbed in the small bowel. However, individuals with a reduced absorptive surface may have difficulty absorbing the entire dose, which can be worsened by extended-release formulations due to their longer absorption time. This can lead to inadequate treatment and potentially treatment failures. It's crucial to consider these factors when treating patients with a history of intestinal surgeries and to measure their plasma levels to ensure adequate treatment. Additionally, renal side effects, such as decreased urine concentrating capacity and increased urine output, are common with lithium use and can lead to increased water intake. These side effects can be more pronounced with multiple doses per day and chronic use, potentially leading to a decline in renal function in some cases. Treatment options include increasing water intake, salty foods, and medications to help manage symptoms.
Managing Lithium Treatment and Potential Kidney Issues: Ensure sufficient trough levels with once-daily dosing, monitor renal function, use diuretics cautiously, and consider beta blockers and potassium for tremors and toxicity.
For managing lithium treatment and potential kidney issues, ensuring sufficient trough levels by giving lithium once a day is crucial. Additionally, diuretics like amelioride can help decrease the tendency towards nephrogenic diabetes insipidus but may raise lithium levels, requiring adjustments. There are no known treatments for the chronic risk of kidney issues, and monitoring with periodic measurement of renal function is advisable. For tremors, beta blockers like propranolol and low doses of potassium can be effective treatments. The number needed to treat for potassium is estimated to be around 4 to 5. Lithium toxicity, characterized by tremors, hyperreflexia, and myoclonic jerks, typically requires different treatments, such as beta blockers or increased potassium intake.
Managing Lithium Side Effects on Thyroid, Parathyroid, and Cardiac Health: Proper monitoring and treatment can effectively manage lithium side effects on thyroid function, parathyroid function, and cardiac health. Hypothyroidism can be corrected with Levothyroxine, parathyroid issues can be monitored, and lithium should not be given to those with sick sinus syndrome.
Lithium, a commonly used medication for managing bipolar disorder, can have side effects related to thyroid function, parathyroid function, and cardiac health. However, these issues can be effectively managed with proper monitoring and treatment. For thyroid function, hypothyroidism should not be a reason to discontinue lithium, as it can be corrected with medication like Levothyroxine. In fact, Levothyroxine can even help reduce rapid cycling in some bipolar patients. For parathyroid function, lithium can cause an increase in plasma calcium and, in some cases, parathyroid adenomas. Monitoring for these issues is recommended during the first year of treatment and annually thereafter. Regarding cardiac health, lithium should not be given to those suffering from sick sinus syndrome, as it can compete with sodium and calcium ions and partially block ion channels in the SA node, potentially leading to heart problems. Overall, with careful monitoring and management of these potential side effects, lithium can continue to be an effective treatment option for many individuals with bipolar disorder.
Discussing the importance of lithium as a mood stabilizer: Lithium is our best option for mood stabilization, yet the US underutilizes it. Expressing gratitude is also important for mental health and keeping podcasts running.
Importance of becoming more familiar with lithium as a mood stabilizer. Dr. Cummings emphasized that lithium is our best option for mood stabilization, yet the US is underutilizing it. Gratitude was also a recurring theme in the conversation, with Dr. Cummings expressing his appreciation for the listeners' kind words and Dr. Hyman acknowledging the importance of expressing gratitude as a means of keeping the podcast running. An iTunes review recently praised Dr. Cummings' wisdom and the value of the interview, and Dr. Hyman agreed that the insights shared in many episodes have been invaluable. Overall, the conversation highlighted the significance of lithium in mental health treatment and the importance of expressing gratitude.