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Lithium Alternatives for Bipolar Disorder

Treatment of bipolar disorder about Lithium therapy. Standard antidepressants are typically not used in the treatment of bipolar disorder, as they may provoke rapid mood swings rather than stabilize mood. Instead, lithium bicarbonate is the main treatment of choice to minimize mood swings. Lithium typically achieves this within 5 to 14 days in about 60 per cent of cases, and has to be taken continually to minimize risk of the onset of depression or mania. Suppes et al. reported relapse rates 28 times higher among individuals who stopped taking lithium when not experiencing symptoms than those who continued its use. How it achieves these therapeutic gains is unclear. It may act on all three processes that appear to infl uence mood: increasing serotonin activity, regulating the activity of second messengers, and/or correcting sodium and potassium activity within the neuron.

Despite its therapeutic potential, the effectiveness of lithium in clinical practice has been less than was hoped for, possibly because of poor adherence to recommended treatment regimes. Between 18 and 53 per cent of those receiving treatment do not adhere to the recommended regime. Reasons for this include side-effects of weight gain, problems with coordination and tremor, excessive thirst and memory disturbances. Psychological factors include a dislike of medication controlling mood, feeling well and seeing no need for medication, and missing the highs of hypomania. In addition, many users complain of a ‘damping down’ of all emotions all the time, which they fi nd problematic. A further caution is that the window between ineffective and toxic doses of lithium is narrow. Too high a dose will result in lithium intoxication, the consequences of which include nausea, vomiting, tremors, kidney dysfunction and, potentially, death. Accordingly, levels of lithium have to be regularly monitored by blood testing, a further disincentive to adherence. A fi nal aspect of research into the effectiveness of lithium has revealed how a surprisingly large number of psychosocial factors moderate its effectiveness. Kleindienst et al. (2005) found that high social status, good family support, and adherence to taking the medication each contributed independently and positively to the effectiveness of lithium therapy. By contrast, living in a high expressed emotion environment, neurotic personality traits, and stressors including unemployment and other adverse life-events, contributed to a poor response to lithium.

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