The Carlat Psychiatry Podcast TIMING: When Lithium Comes First
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Feb 17, 2025 This discussion emphasizes the crucial role of lithium in managing bipolar disorder, highlighting its historical significance and current underutilization. Experts explore its effectiveness compared to antipsychotics in younger patients and how it enhances overall functioning. The podcast also delves into lithium's biological mechanisms and its surprising anti-aging properties. Additionally, listeners learn about lithium's ability to normalize circadian rhythms and its impact on reducing cognitive decline. Practical advice for clinicians on monitoring patient safety is also shared.
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Lithium's Resurgence
- Lithium prescriptions have fallen since their peak in the 1980s and early 1990s.
- New guidelines prioritize lithium for long-term bipolar treatment, despite some child/adolescent guidelines favoring antipsychotics.
Early Lithium Intervention
- Studies suggest lithium may be particularly effective when initiated early in bipolar disorder.
- In a study, patients were 18 times more likely to remain well on lithium compared to quetiapine.
Lithium's Mechanisms of Action
- Lithium may have disease-modifying effects by calming hyperexcitable neurons and normalizing circadian rhythms.
- It also demonstrates neuroprotective and anti-aging properties, potentially contributing to a longer lifespan.