Lithium efficacy in bipolar depression with flexible dosing: A six-week, open-label, proof-of-concept study

Author(s)

Machado-Vieira, Rodrigo ^{[1, 2]} ; Zanetti, Marcus V. ^{[1, 2]} ; De Sousa, Rafael T. ^{[2, 3]} ; Soeiro-De-Souza, Marcio G. ^[3] ; Moreno, Ricardo A. ^[3] ; Busatto, Geraldo F. ^[1] ; Gattaz, Wagner F. ^{[1, 2]}

Affiliation

^[1] Univ Sao Paulo, Ctr Interdisciplinary Res Appl Neurosci NAPNA, Sao Paulo - Brazil

^[2] Univ Sao Paulo HC FMUSP, Sch Med, Dept & Inst Psychiat, Lab Neurosci LIM 27, BR-01060970 Sao Paulo - Brazil

^[3] Univ Sao Paulo HC FMUSP, Sch Med, Dept & Inst Psychiat, Mood Disorders Unit GRUDA, Sao Paulo - Brazil

• Document type: Journal article
• Source: EXPERIMENTAL AND THERAPEUTIC MEDICINE; v. 8, n. 4, p. 1205-1208, OCT 2014.
• Web of Science Citations: 5

Abstract

Lithium has a narrow therapeutic index with a subtle balance between effectiveness and adverse effects. Current guidelines recommend the use of lithium as a treatment for acute bipolar depression; however, the therapeutic range for the treatment has not been fully defined. Recently, the adjunctive lower lithium dose in bipolar depression has revealed potential efficacy; however, no study has investigated it predominantly in monotherapy. In this open-label, proof-of-concept study, 31 individuals with bipolar disorder during a depressive episode were randomized and 29 were followed up for six weeks with flexible lithium dosing. All subjects had a 21-item Hamilton Rating Scale for Depression (HAM-D) score of >= 18 at baseline. Subjects were divided into two groups, with higher (Li >= 0.5 mEq/l) or lower (Li <0.5 mEq/l) blood lithium levels. Response and remission rates were evaluated using the HAM-D scores. Following 6 weeks of lithium treatment, the remission rate for all patients was 62.0%. The plasma lithium levels did not impact the clinical response. However, subjects with higher blood lithium levels had an increased prevalence of nausea, restlessness, headaches and cognitive complaints. The results indicate that the lithium dose for the treatment of bipolar depression in an individual should be based on the clinical efficacy and side-effects. In the context of personalized psychiatric treatments, it is necessary to evaluate the therapeutic action of lithium with individual regimens in order to develop more tolerable and effective treatment approaches. (AU)

• FAPESP's process: 09/14891-9 - Longitudinal study on the neuroprotective and neurotrophic effects of lithium in bipolar disorder: identification of cellular and molecular targets clinically relevant
• Grantee: Rodrigo Machado-Vieira
• Support Opportunities: Research Grants - Young Investigators Grants