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Bipolar Disorder


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Lithium treatment for Bipolar Disorder? 

The use of lithium for the treatment of bipolar disorder has been nothing less than a true miracle drug for many individuals who have struggled with this difficult disorder for many years.  However, determining the correct lithium dosage for a given patient is considered a very delicate process, requiring constant analysis of urine and blood samples, as well as other laboratory tests.  Too low of a dose of lithium can have little or no effect, and too high of a dose can be toxic, resulting in symptoms of nausea, vomiting, sluggishness, tremors, dizziness, slurred speech, sodium imbalance, seizures, kidney dysfunction, and even death.  The correct dose however, can bring significant improvement in mood within five to 14 days.  Some patients respond better to other drugs such as the antiseizure drugs Carbamazepine (Tegretol) or valproate (Depakote), or a combination of such drugs. 


Origin of lithium treatment: 

The discovery of the effectiveness of lithium, like many other medical discoveries was found quite accidentally.  An Australian psychiatrist John Cade in 1949, hypothesized that manic behavior is caused by a toxic level of uric acid in the body.  He began testing his theory by injecting guinea pigs with uric acid, but first combined lithium to increase its solubility. 

Cade was very surprised to see that the guinea pigs became lethargic rather than manic after their injections.  He suspected that lithium had produced this effect, and later administered lithium to 10 human beings who had mania, and discovered that it calmed and normalized their mood.  Although many countries began using lithium for bipolar disorder soon after that time, it was not until 1970 that the Food and Drug Administration approved it for use in the United States. 

Effectiveness of lithium:

A significant amount of research on lithium has overwhelmingly concluded that it is effective in treating manic episodes.  More than 60% of individuals treated with lithium are believed to have improved manic symptoms when taking this medication.  Also, most of them experience fewer subsequent episodes if they continue taking their medication.  One study found that the risk of relapse is 28 times higher for patients who stop taking lithium. These findings suggest that it may also have a preventative effect in actually preventing symptoms from developing.  Accordingly, many contemporary clinicians continue patients on some level of lithium even after their manic episodes subside.  It is also believed that lithium helps patients to overcome depressive episodes, although it is probably to a lesser degree than to the degree that it helps with their manic episodes. 

These findings have also led researchers to investigate whether lithium might also be helpful in cases of unipolar depression, but have had somewhat mixed results.  Some studies have found that lithium is helpful for patients with unipolar depression and occasionally prevents recurrences.  However, it is possible that “unipolar” patients helped by lithium actually have a bipolar disorder, whose manic episode is yet to appear. 

Another advantage of using lithium is that it has sometimes been found to enhance the effectiveness of antidepressant drugs prescribed for unipolar depression.  In one study up to two thirds of “tricyclic nonrespondent” patients were converted to “responders” when lithium was added to the antidepressant drug therapy.

Adapted from information from Abnormal Psychology by Ronald J. Comer

Additional information and webpage by Paul Susic MA Licensed Psychologist Ph.D Candidate (Health Psychology)

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