Peet M, Pratt J P
Northern General Hospital, Sheffield, England.
Drugs. 1993 Jul;46(1):7-17. doi: 10.2165/00003495-199346010-00002.
Lithium is the recommended treatment for the prophylaxis of bipolar affective disorder. The drug is also effective in the prophylactic treatment of recurrent unipolar depression, although many psychiatrists prefer to use antidepressant drugs for this indication. The efficacy of lithium is well established in the short term treatment of mania, although neuroleptic drugs are required at the start of treatment for more severely disturbed patients. Lithium augmentation of antidepressant drugs is increasingly popular for the treatment of resistant depression. It is now common practice to maintain serum lithium concentrations in the range 0.5 to 0.8 mmol/L, which is generally as effective as higher concentrations while reducing the incidence of adverse effects and intoxication. Some individuals may nevertheless require higher serum concentrations. Most adverse effects such as tremor and gastrointestinal upset are usually minor and often transient. There is no good evidence of nephrotoxicity with long term treatment, but persistent polyuria can occur. Hypothyroidism, with or without goitre, can occur uncommonly during long term lithium therapy. Prescribers should be alert to, and patients should be educated about, the predisposing factors and early symptoms relating to lithium intoxication. Specialist mood disorder clinics can facilitate safer and more effective lithium treatment.
锂盐是预防双相情感障碍的推荐治疗药物。该药物对复发性单相抑郁的预防性治疗也有效，尽管许多精神科医生更倾向于使用抗抑郁药物来治疗这一适应症。锂盐在躁狂症的短期治疗中疗效已得到充分证实，尽管对于病情更严重的患者在治疗开始时需要使用抗精神病药物。锂盐增强抗抑郁药物治疗难治性抑郁症越来越普遍。目前的常见做法是将血清锂浓度维持在0.5至0.8 mmol/L范围内，这通常与更高浓度一样有效，同时可降低不良反应和中毒的发生率。不过，有些人可能需要更高的血清浓度。大多数不良反应，如震颤和胃肠道不适，通常较轻且往往是短暂的。长期治疗没有充分证据表明会出现肾毒性，但可能会发生持续性多尿。长期锂盐治疗期间，甲状腺功能减退症（无论有无甲状腺肿）可能罕见发生。开处方者应警惕锂盐中毒的诱发因素和早期症状，并应对患者进行相关教育。专业的情绪障碍诊所可以促进更安全、更有效的锂盐治疗。
