Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.
Curr Neuropharmacol. 2019;17(4):318-341. doi: 10.2174/1570159X16666171219142120.
Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications.
To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data.
Clinical trials in pediatric samples with at least one standardized measure of efficacy/ effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients.
Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe.
Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.
锂是成人双相情感障碍的一线治疗药物，但作用机制仍远未明确。此外，锂在儿科人群中的使用证据很少，不仅在双相情感障碍方面，在其他可能的适应症方面也是如此。
提供已发表的关于锂可能作用机制以及在儿科样本中使用的数据综述，包括药代动力学、疗效和安全性数据。
本综述纳入了至少有一项疗效/有效性标准化测量的儿科样本临床试验。我们考虑了：i）随机和开放标签试验，ii）联合研究，iii）增效研究，iv）至少包括 5 例患者的病例系列。
不同的非替代性作用机制可以解释锂的临床疗效。儿科样本的临床研究表明，锂在治疗双相情感障碍的躁狂症状/发作方面有效，无论是在急性期还是维持治疗策略中。锂对双相情感障碍的抑郁症状/阶段的疗效则不太明确，而研究不支持其用于单相抑郁和严重情绪失调。相反，它可能对品行障碍中的攻击行为有效。其他可能的适应症，其证据有限，包括 Kleine-Levin 综合征的急性发作、X 脆性综合征的行为症状以及氯氮平或化疗引起的中性粒细胞减少症的管理。一般来说，锂的结果相对安全。
锂似乎是治疗儿科双相情感障碍和攻击行为的有效且耐受良好的药物，而其他临床适应症则需要更多证据。
