Department of Adult Psychiatry, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznan, Poland.
Department of Adult Psychiatry, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznan, Poland.
Neurosci Lett. 2022 Apr 23;777:136590. doi: 10.1016/j.neulet.2022.136590. Epub 2022 Mar 25.
This mini-review aims to show a discrepancy between favorable data of lithium's therapeutic activity and the decreased use of the drug worldwide. The data point to lithium as the best mood stabilizer in the maintenance treatment of bipolar disorder for the prevention of manic and depressive recurrences. The second most encouraging psychiatric use of lithium is the augmentation of antidepressants in treatment-resistant depression. In addition to its mood-stabilizing properties, lithium is the most efficacious antisuicidal drug among all mood stabilizers. The drug also exerts antiviral, immunomodulatory, and neuroprotective effects which may be of major clinical value. On the other hand, the data of lithium use show that its therapeutic application in many countries has declined. A reason for this can be the introduction and heavy promotion of other mood-stabilizers, while lithium is an "orphan" drug with the minimal interest of any drug company. Probably, very important is also a perception of lithium as a "toxic drug", pointing to its side effects, mainly thyroid, renal and cognitive ones. In recent years, several proposals to turn back this anomalous association appeared, challenging a negative perception of lithium and optimizing its long-term administration. They show the data on lithium superiority over other mood stabilizers and point to the proper management of the lithium-induced side effects. This endeavor aims to allow a larger number of mood disorder patients to become beneficiaries of lithium use.
这篇小型综述旨在展示锂的治疗活性的有利数据与全球范围内锂的使用减少之间的差异。数据表明，锂是双相情感障碍维持治疗中预防躁狂和抑郁复发的最佳心境稳定剂。锂的第二种最令人鼓舞的精神科用途是增强抗抑郁药治疗抵抗性抑郁症。除了稳定情绪的特性外，锂是所有心境稳定剂中最有效的抗自杀药物。该药物还具有抗病毒、免疫调节和神经保护作用，这可能具有重要的临床价值。另一方面，锂的使用数据表明，其在许多国家的治疗应用已经减少。原因之一可能是其他心境稳定剂的引入和大力推广，而锂是一种“孤儿药”，任何制药公司都没有太大兴趣。可能同样重要的是，人们认为锂是一种“有毒药物”，这指向其副作用，主要是甲状腺、肾脏和认知方面的副作用。近年来，出现了一些扭转这种异常关联的提议，挑战了对锂的负面看法，并优化了其长期管理。这些提议展示了锂相对于其他心境稳定剂的优势，并指出了适当管理锂引起的副作用。这一努力旨在让更多的心境障碍患者受益于锂的使用。
