Bschor T, Bauer M
Nervenarzt. 2013 Jul;84(7):860-3. doi: 10.1007/s00115-013-3766-z.
Lithium is the only drug that obtained the highest level of recommendation for maintenance therapy in the recent German S3 guidelines on bipolar disorders. In addition it is the only drug with proven efficacy for the prevention of manic as well as depressive episodes in studies with a non-enriched design. Therefore, it is highly welcomed that The Lancet recently published a systematic review and meta-analysis on the risks and side effects of lithium. This is the most comprehensive review on this topic so far.The glomerular filtration rate and maximum urinary concentration ability are slightly reduced under lithium. More patients suffered from renal failure compared to controls; however, renal failure remains a very rare event. The review confirmed the well known suppressive effects of lithium on the thyroid. An increase of serum calcium could be observed relatively frequently, therefore, regular control of serum calcium under lithium therapy is recommended. A relevant increase in body weight is more frequent under lithium than under placebo but less frequent than under olanzapine. No statistically significant increase could be found for hair loss, skin disorders or major congenital abnormalities.Lithium treatment is a safe therapy when clinicians follow the established recommendations. Data indicate that a risk for renal failure exists especially in patients without regular monitoring or with too high lithium serum levels. A (subclinical) hypothyroidism is not an indication to stop administration of lithium but is an indication for l-thyroxin substitution therapy. In pregnancy the risks of continuing lithium should be balanced against the risks of stopping lithium together with the patient.
锂盐是近期德国关于双相情感障碍的S3指南中唯一获得维持治疗最高推荐级别的药物。此外，在非富集设计的研究中，它是唯一被证实对预防躁狂发作和抑郁发作均有效的药物。因此，《柳叶刀》最近发表了一篇关于锂盐风险和副作用的系统评价和荟萃分析，这是非常值得欢迎的。这是迄今为止关于该主题最全面的综述。在锂盐治疗下，肾小球滤过率和最大尿浓缩能力会略有降低。与对照组相比，更多患者出现肾衰竭；然而，肾衰竭仍然是非常罕见的事件。该综述证实了锂盐对甲状腺的抑制作用是众所周知的。相对频繁地观察到血清钙升高，因此，建议在锂盐治疗期间定期监测血清钙。与安慰剂相比，锂盐治疗下体重相关增加更为常见，但比奥氮平治疗下少见。未发现脱发、皮肤疾病或重大先天性异常有统计学意义的增加。当临床医生遵循既定建议时，锂盐治疗是一种安全的治疗方法。数据表明，肾衰竭风险尤其存在于未进行定期监测或血清锂水平过高的患者中。（亚临床）甲状腺功能减退并非停用锂盐的指征，而是左甲状腺素替代治疗的指征。在孕期，应将继续使用锂盐的风险与和患者一起停用锂盐的风险进行权衡。
