Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Klinika Psychiatrii Dorosłych.
Psychiatr Pol. 2020 Dec 31;54(6):1047-1066. doi: 10.12740/PP/128340.
The paper presents the current state of knowledge on lithium treatment. The history of the therapeutic application of lithium began in 1859 and its introduction to modern psychiatry took place 90 years later. Since the early 1960s, lithium became a precursor of mood-stabilizing drugs and nowadays is the drug of choice for the prevention of manic and depressive recurrences in mood disorders. It remains a valuable drug for the treatment of acute episodes of mania and depression, especially for the augmentation of antidepressant drugs in treatment resistant depression. The factors of prophylactic efficacy of lithium in the context of the so-called excellent lithium responders and the efficacy in affective episodes were discussed. Among mood-stabilizing drugs, lithium exerts the biggest effect on preventing suicidal behaviors. It also shows antiviral (mainly against herpes viruses) and immunomodulatory activity. The evidence has recently been gathered on neuroprotective and ‛antidementia' properties of lithium, which prompted its use in neurodegenerative disorders. The biochemical mechanism of lithium is associated mainly with the inhibition of glycogen synthase kinase-3 and an effect on intracellular signaling. The recommendations for managing lithium-induced adverse effects both in the early and late period of treatment as well as for lithium use in pregnancy and perinatal period were given. The necessity of overcoming negative perceptions of lithium was pointed out to increase the number of possible beneficiaries of lithium treatment. Both introduction of lithium into modern psychiatry and its therapeutic effects have been reflected in literature and art.
本文介绍了锂治疗的现状。锂的治疗应用历史始于 1859 年，其在现代精神病学中的应用则始于 90 年后。自 20 世纪 60 年代初以来，锂成为心境稳定剂的先驱药物，如今是预防心境障碍躁狂和抑郁复发的首选药物。它仍然是治疗急性躁狂和抑郁发作的有效药物，特别是在治疗抵抗性抑郁症中，作为抗抑郁药物的增效剂。本文讨论了锂在所谓的“优秀锂应答者”中的预防疗效和在情感发作中的疗效的相关因素。在心境稳定剂中，锂对预防自杀行为的效果最大。它还具有抗病毒（主要是针对疱疹病毒）和免疫调节作用。最近，锂具有神经保护和“抗痴呆”作用的证据已经被收集，这促使其在神经退行性疾病中使用。锂的生化机制主要与抑制糖原合成酶激酶-3和对细胞内信号的影响有关。本文还给出了锂治疗期间早期和晚期管理锂引起的不良反应的建议，以及锂在妊娠和围产期的使用建议。为了增加可能受益于锂治疗的人数，有必要克服对锂的负面看法。锂引入现代精神病学及其治疗效果都在文学和艺术中得到了反映。
