Department of Neuroscience, Section of Psychiatry, Catholic University of the Sacred Heart of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2021 Sep;25(17):5483-5489. doi: 10.26355/eurrev_202109_26657.
Patients with bipolar disorder (BD) experience a poor quality of life (QoL) and a weak adherence to the therapy due to the various side effects occurring during the pharmacological therapy. To date clinicians have no tools to intervene on such effects, considering them as an unavoidable part of the therapy. This review paves the way for a step forward in the management of patients with BD bridging the therapeutic gap in clinical practice.
We reviewed the literature, searching through different databases (MEDLINE, Scopus, Google Scholar). We used different keywords, including bipolar disorder, lithium and valproic acid, inositol role in bipolar disorder, side effects, inositol depletion, supplementation of inositols under lithium treatment, inositol role in metabolism, hypothyroidism, renal and cardiac functionality. In particular, we narrowed the search down to English literature, excluding works before 1980s. Regarding clinical studies, we included case reports and both preclinical and clinical studies, especially only those exhibiting a control group. The outcome of the database search was to highlight the threat of side effects and the relationship with inositol lower levels, paving the way for a step forward in the management of patients with BD.
Based on the collected evidence, the combined administration of myo-inositol (myo-ins) and d-chiro-inositol (d-chiro-ins) is strongly recommended in order to restore levels and metabolism of inositols. Previous studies pointed out the beneficial effects of inositols in recovering pathological conditions, like polycystic ovary syndrome (PCOS), hypothyroidism, weight gain, cardiac functionality, being all these conditions related to the depletion of inositols. Furthermore, a controlled dosage of inositols, up to 6 grams/daily, may reduce the side effects caused by lithium therapy, without hindering its central therapeutic role on patients' mood.
Considering the iatrogenic depletion of inositols, the tailored ratio 80:1 in favour of myo-ins, may become a safe and effective strategy to counteract side effects, by providing a large amount of myo-ins and an adequate one of d-chiro-ins. The clinical dosage of inositols used as dietary supplementation is 4 grams/daily, and it may allow the recovery of the side effects and improve patients' QoL, without reducing the central therapeutic effect of the pharmacological therapy.
由于药物治疗过程中出现的各种副作用，双相情感障碍（BD）患者的生活质量（QoL）较差，且对治疗的依从性较弱。迄今为止，由于将这些副作用视为治疗不可避免的一部分，临床医生尚无干预这些副作用的手段。本综述为在临床实践中治疗 BD 患者的方法提供了新的思路，填补了治疗空白。
我们通过不同的数据库（MEDLINE、Scopus、Google Scholar）进行文献回顾，使用了包括“bipolar disorder”“lithium and valproic acid”“inositol role in bipolar disorder”“side effects”“inositol depletion”“supplementation of inositols under lithium treatment”“inositol role in metabolism”“hypothyroidism”“renal and cardiac functionality”等不同的关键词。我们特别将搜索范围缩小到英语文献，并排除了 20 世纪 80 年代以前的文献。对于临床研究，我们包括了病例报告和临床前及临床研究，特别是那些有对照组的研究。数据库搜索的结果强调了副作用的威胁及其与肌醇水平降低的关系，为治疗 BD 患者的方法提供了新的思路。
基于收集到的证据，强烈建议联合使用肌醇（myo-ins）和 D-手性肌醇（d-chiro-ins），以恢复肌醇的水平和代谢。先前的研究指出，肌醇在恢复多囊卵巢综合征（PCOS）、甲状腺功能减退、体重增加、心脏功能等病理状况方面具有有益作用，所有这些状况都与肌醇的消耗有关。此外，每天 6 克的肌醇剂量可以减少锂治疗引起的副作用，而不会影响其对患者情绪的中心治疗作用。
鉴于肌醇的医源性消耗，80:1 的比例有利于肌醇，可以成为一种安全有效的策略，通过提供大量的肌醇和适量的 D-手性肌醇来对抗副作用。作为膳食补充剂使用的肌醇临床剂量为每天 4 克，它可以恢复副作用，提高患者的生活质量，而不会降低药物治疗的中心治疗效果。
