Severus W E, Kleindienst N, Seemüller F, Frangou S, Möller H J, Greil W
Department of Psychiatry, University of Munich, Munich, Germany.
Bipolar Disord. 2008 Mar;10(2):231-7. doi: 10.1111/j.1399-5618.2007.00475.x.
There is substantial uncertainty about the most efficacious serum lithium level for the long-term treatment of bipolar disorder (BD). This review focuses on the available evidence taking into consideration the effects of previous lithium history, changes in lithium level and polarity of relapse or recurrence.
We conducted a MEDLINE search, using the MeSH Terms 'bipolar disorder' and 'lithium' together with 'randomized controlled trial' or 'controlled clinical trial' covering the time span from 1966 to March 2006. We only included studies reporting on the long-term treatment of mood disorders where patients with BD were examined as a separate group and were assigned to precisely specified target ranges of lithium level.
The minimum efficacious serum lithium level in the long-term treatment of bipolar disorder was 0.4 mmol/L with optimal response achieved at serum levels between 0.6-0.75 mmol/L. Lithium levels >0.75 mmol/L may not confer additional protection against overall morbidity but may further improve control of inter-episode manic symptoms. Abrupt reduction of serum levels of more than 0.2 mmol/L was associated with increased risk of relapse.
In the long-term treatment of bipolar disorder clinicians should initially aim for serum lithium levels of 0.6-0.75 mmol/L, while higher levels may benefit patients with predominantly manic symptoms.
对于双相情感障碍（BD）长期治疗的最有效血清锂水平存在很大不确定性。本综述考虑既往锂治疗史、锂水平变化以及复发或再发的极性等影响因素，聚焦于现有证据。
我们使用医学主题词“双相情感障碍”和“锂”，结合“随机对照试验”或“对照临床试验”，对1966年至2006年3月期间的MEDLINE数据库进行检索。我们仅纳入了报告心境障碍长期治疗的研究，其中双相情感障碍患者作为一个单独的组进行检查，并被分配到精确指定的锂水平目标范围。
双相情感障碍长期治疗的最低有效血清锂水平为0.4 mmol/L，血清水平在0.6 - 0.75 mmol/L之间可达到最佳反应。锂水平>0.75 mmol/L可能不会对总体发病率提供额外保护，但可能进一步改善发作间期躁狂症状的控制。血清水平突然降低超过0.2 mmol/L与复发风险增加相关。
在双相情感障碍的长期治疗中，临床医生最初应将血清锂水平目标设定为0.6 - 0.75 mmol/L，而较高水平可能使以躁狂症状为主的患者受益。
