Gitlin Michael, Bauer Michael
Department of Psychiatry, Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza, Suite 2200, Los Angeles, CA, 90095, USA.
Department of Psychiatry, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany.
Int J Bipolar Disord. 2024 Nov 28;12(1):40. doi: 10.1186/s40345-024-00362-7.
Lithium is our oldest continuously prescribed medication in psychopharmacology, with its history as an agent for treating mood disorders extending from the 19th century. Although clinicians prescribe it less frequently than in the past, its utility in treating bipolar disorder is unquestionable. Novel potential indications for its use in psychiatry have created excitement about broader roles for lithium in treating and preventing other disorders.
Lithium is effective both in treating acute mania, as an adjunctive antidepressant, and as a maintenance treatment in bipolar disorder. Lithium has also shown some efficacy in treating and preventing unipolar depression, but less clearly than for bipolar maintenance treatment and acute mania. Common side effects include nausea, polyuria, tremor, weight gain and cognitive dulling. These side effects are typically manageable with reasonable clinical strategies. Lithium affects renal, thyroid and parathyroid function. With clinical monitoring, these effects are easily managed although infrequent cases of severe renal insufficiency may occur with long term use. Although not all studies are positive, a consistent database suggests the efficacy of lithium in decreasing suicide attempts and suicides, likely due to its effect on impulsivity and aggression as well as its prophylaxis against depressive and manic recurrences. Recent data have suggested lithium's potential efficacy for a number of new clinical indications. Lithium's neuroprotective effects suggest potential efficacy in preventing mild cognitive impairment (MCI) and dementia as well as in aiding recovery from strokes. Higher (but still trace) lithium levels in drinking water are associated with lower rates of dementia. It is still not clear how much lithium-and what serum lithium levels- are required for either of these effects. Other preliminary research suggests that lithium may also have antiviral effects and may decrease cancer risk.
Lithium continues to be the mainstay treatment of mood disorders in general and in bipolar disorder specifically. Other potential clinical uses for lithium in psychiatry have re-invigorated excitement for research in other areas such as suicide, preventing cognitive impairment and possibly preventing viral infections and diminishing cancer risk.
锂盐是精神药理学中使用历史最悠久且持续应用至今的药物，其作为治疗心境障碍的药物的历史可追溯到19世纪。尽管临床医生如今开具锂盐处方的频率低于过去，但它在治疗双相情感障碍方面的效用是毋庸置疑的。锂盐在精神病学领域的新潜在适应证引发了人们对其在治疗和预防其他疾病方面发挥更广泛作用的期待。
锂盐在治疗急性躁狂发作、作为辅助抗抑郁药以及双相情感障碍的维持治疗方面均有效。锂盐在治疗和预防单相抑郁方面也显示出一定疗效，但不如在双相情感障碍维持治疗和急性躁狂发作方面那么明确。常见副作用包括恶心、多尿、震颤、体重增加和认知迟钝。这些副作用通常可通过合理的临床策略加以控制。锂盐会影响肾脏、甲状腺和甲状旁腺功能。通过临床监测，这些影响虽易于控制，但长期使用可能会偶发严重肾功能不全的病例。尽管并非所有研究结果都是积极的，但一个连贯的数据库表明锂盐在降低自杀企图和自杀行为方面具有疗效，这可能归因于其对冲动性和攻击性的影响以及对抑郁和躁狂复发的预防作用。近期数据表明锂盐对一些新的临床适应证可能有效。锂盐的神经保护作用提示其在预防轻度认知障碍（MCI）和痴呆以及辅助中风康复方面可能有效。饮用水中锂含量较高（但仍为微量）与痴呆发病率较低相关。目前尚不清楚实现上述任何一种效果需要多少锂盐以及血清锂水平应为多少。其他初步研究表明锂盐可能还具有抗病毒作用并可能降低癌症风险。
锂盐仍然是总体心境障碍尤其是双相情感障碍的主要治疗药物。锂盐在精神病学领域的其他潜在临床用途重新激发了人们对自杀、预防认知障碍以及可能预防病毒感染和降低癌症风险等其他领域研究的兴趣。
