The podcast discusses the latest research on lithium, including its efficacy in treating bipolar disorder and unipolar depression, its impact on suicide rates and psychosocial functioning, and its role in augmenting antidepressants. It also explores the side effects and patient experiences of lithium compared to quatypine, the effectiveness of different lithium treatments for tremor in bipolar disorder, and renal risk factors associated with lithium use.
Lithium is effective in reducing suicide attempts, improving long-term functioning, and lowering hospitalization rates for bipolar and unipolar depression, challenging the perception that antipsychotics have better evidence in treating bipolar depression.
Lithium consistently emerges as a favorable choice for augmentation therapy in the treatment of resistant depression, along with intravenous ketamine, based on a network meta-analysis of trials comparing augmentation strategies.
Deep dives
Lithium's superior efficacy in the early course of bipolar disorder
The International Society of Bipolar Disorders released guidelines suggesting that lithium use in the early stages of bipolar disorder lowers the risk of recurrence compared to other mood stabilizers. Observational studies have also shown that lithium is effective in reducing suicide attempts, improving long-term functioning, and lowering hospitalization rates for bipolar and unipolar depression. These findings challenge the perception that antipsychotics have better evidence in treating bipolar depression than lithium.
Comparing augmentation strategies for treatment-resistant depression
A network meta-analysis of trials comparing augmentation strategies for treatment-resistant depression found that lithium and intravenous ketamine were the most effective and tolerable options. While different studies may rank these options differently, lithium consistently emerges as a favorable choice for augmentation therapy.
Assessing the risks and benefits of lithium
Lithium offers several medical benefits, including reducing the risk of COVID infection, cancer, osteoporosis, dementia, and all-cause mortality in patients with bipolar disorder. However, it is associated with renal impairment, with long-term use potentially doubling the risk of renal disease. Managing the risks of lithium requires monitoring kidney function, considering dose and duration, and using extended-release formulations and nighttime dosing to minimize adverse effects.
Chris Aiken, MD, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
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