George Washington University School of Medicine, Bipolar Collaborative Network, Bethesda, MD, USA.
Neuropsychopharmacology. 2018 Apr;43(5):1174-1179. doi: 10.1038/npp.2017.238. Epub 2017 Oct 4.
Lithium use for the treatment of mood disorders remains quite low, particularly in the United States compared with some European countries. Mogens Schou pioneered the study of lithium for prophylaxis of the recurrent mood disorder and encouraged its greater use. In an effort to further address the appropriate role of this drug, the multiple assets of lithium beyond its well-known antimanic effect are reviewed, and a brief summary of its side effects is outlined. It appears that lithium has positive effects in depression and suicide prevention, cognition, and reducing the incidence of dementia. It increases the length of telomeres and has positive effects in prevention of some medical illnesses. Lithium side-effect burden, especially its association with end-stage renal disease, may be less than many have surmised. New data indicate the importance of long-term prophylaxis after a first manic episode to lessen episode recurrence, allow cognition to recover to normal, and prevent various aspects of illness progression. After a first manic episode, 1 year of randomized treatment with lithium was superior to that of quetiapine, suggesting the importance of having lithium in the treatment regimen. Given the highly recurrent and progressive course of bipolar disorder sometimes even in the face of conventional treatment, the role and enhanced use of lithium deserves reconsideration.
锂盐在心境障碍治疗中的应用仍然较低，特别是与一些欧洲国家相比，在美国更是如此。Mogens Schou 开创了锂盐预防复发性心境障碍的研究，并鼓励其更广泛的应用。为了进一步探讨该药的适当作用，本文综述了锂盐除了众所周知的抗躁狂作用之外的多种作用机制，并简要概述了其不良反应。研究表明，锂盐在预防抑郁、自杀、认知障碍和减少痴呆症的发生方面具有积极作用。它可以延长端粒的长度，并对预防某些疾病有积极作用。锂盐的不良反应负担，特别是与终末期肾病的关系，可能比许多人推测的要小。新数据表明，在首次躁狂发作后进行长期预防治疗对于减少发作复发、恢复正常认知以及预防疾病进展的各个方面都很重要。在首次躁狂发作后，为期 1 年的锂盐随机治疗优于喹硫平，表明在治疗方案中使用锂盐的重要性。鉴于双相情感障碍的高度复发性和进行性，有时即使采用常规治疗，锂盐的作用和增强使用也值得重新考虑。
