Lithium for Depression and Bipolar Disorder Is It Effective?

Lithium can be used to treat depression and bipolar disorder thanks to its mood stabilizing properties. It is a drug that is normally used to treat and prevent the typical episodes of mania that are experienced in bipolar disorder.

Lithium is a drug that is part of the drugs known as mood stabilizers.

Lithium for depression

Thus, it is only with the first approximation about what lithium is clear that its mechanism of action is to stabilize the mood, that is, to ensure that the affection is neither excessively high nor excessively low.

Lithium for Depression

However, the mechanism of action of lithium is not fully known. It is believed that this acts by modifying systems of second messengers.

In fact, the hypothesis most strongly held today is that lithium alters G proteins and their ability to send signals into the cell once the receptor is occupied by the neurotransmitter.

Explained in a less technical way, this would mean that lithium would be able to stabilize mood through indirect mechanisms.

That is, lithium could alter mental functioning and return it to a stabilized state by modifying the actions of proteins that determine the functioning of neurons.

Lithium to treat depression

Lithium is not considered a first-line drug to treat depressions due to the existence of more effective drugs to reduce the symptoms that occur in this disease.

Thus, the most commonly used drugs to treat depressive episodes of depression are heterocyclic antidepressants (such as impipramine), SSRI antidepressants (such as paroxetine) and new antidepressants (such as mirtazapine).

This fact would be explained because antidepressants have a more direct effect on the elevation of mood. While lithium allows you to stabilize (increase or reduce) mood, antidepressants can lift it directly.

Thus, in depressions the use of lithium is reduced to the combination with some antidepressant in the phases of maintenance to prevent relapses and recurrences.

However, the same is not true in the treatment of depressive episodes of bipolar disorder.

In these episodes, although the symptoms may be very similar to those shown during depression, the use of lithium becomes much more important and becomes a vital drug for treatment.

This effect is explained by the characteristics of bipolar disorder.

As we have said before, bipolar disorder is characterized by the presentation of depressive episodes which are followed by the appearance of manic episodes.

Thus, when a depressive episode appears, it is very likely that a manic episode later appears.

Therefore, the use of antidepressants during these phases is generally discouraged as these can elevate the mood quickly and cause the onset of a manic episode immediately.

Thus, in these cases, lithium becomes the drug of first choice, since this, although it will raise the mood in a slower and less effective way than the antidepressant will prevent the occurrence of a manic episode.

Lithium to treat bipolar disorder

Pharmacological treatment of bipolar disorder continues to be a challenge for psychiatrists today, since each phase of the disease usually requires a different therapeutic approach.

Nevertheless, during the last 50 years some changes in the trends of use of the different drugs available to treat this type of psychopathological alteration have been experienced.

In this sense, lithium has been, and continues to be, the drug par excellence for bipolar disorder. In fact, in the 1950s and 1960s it already had acceptance in Europe and is still maintained today.

Recently, the Collegial Medical Organization and the Ministry of Health and Consumer Affairs have developed a manual of action in the case of mania that collects the evidence in favor of the use of lithium in these pathologies.

Specifically, this study has demonstrated strong evidence for the use of lithium in acute mania, i.e. in those cases where manic symptoms are expressed autonomously.

Thus, the study demonstrated how in controlled and randomized trials of this type of psychopathologies, lithium achieved a good pharmacological response in practically all cases.

However, in this same study, lithium only obtained limited evidence on its effectiveness in treating cases of mixed mania, i.e. to intervene in those episodes presenting depressive symptoms and manic symptoms simultaneously.

In these cases, other drugs such as evaporate or cabramazepine demonstrated a greater effectiveness of treatment.

Thus, lithium has been shown to have a greater effectiveness in the treatment of manic episodes than in the treatment of mixed episodes, so the diagnosis of these characteristics of bipolar disorder becomes very important when specifying the therapeutic plan.

As regards the hippomanic phases, it has been demonstrated that lithium is an effective drug to attenuate its symptoms, to stabilize the mood and to recover an optimal operation.

This was evidenced by a retrospective study by Tone on the efficacy of lithium to reverse hippomanic phases in a total of 129 people with type II bipolar disorder.

In addition, in this same study, the effects of lithium were studied to treat the manic symptoms presented in a total of 188 individuals diagnosed with type I bipolar disorder.

In this second review of Tone, it was found that the efficacy of lithium was more effective in treating hyperthymic symptoms (manic episodes and hippomanic episodes) than in treating hypothermic symptoms (depressive episodes).

Finally, it should be noted that other types of drugs are often added to the treatment with lithium for bipolar disorder.


Multiple studies have shown that certain antipsychotics interact well with lithium and increase the potential for treatment to reverse the symptoms of bipolar disorder.

More specifically, in the manual developed by the Collegiate Medical Organization and the Ministry of Health and Consumer Affairs, Haloperidol, Risperidone, Olanzapine, Quetiapine and Arpiprazole were found to be optimal drugs to accompany treatment with lithium.

 

Finally, it should be noted that, as demonstrated by Goodwin and Jamison in 1990, lithium is a drug suitable for the maintenance treatment of bipolar disorder since it reduces the frequency, duration and intensity of manic, hippomanic and depressive episodes.

Thus, from all of this we can draw the following conclusions about the efficacy of lithium for bipolar disorder:

  1. Lithium is the drug most commonly used to treat bipolar disorders.
  2. Together with other mood stabilizers like Carbamazepine or Valrico Acid is the first choice treatment.
  3. Lithium is used more frequently than Carbamazepine and Valrico Acid to demonstrate higher rates of efficacy in the treatment of bipolar disorder.
  4. Lithium is especially effective in treating the manic and hippomanic symptoms of bipolar disorder and achieving a decrease in mood by stabilizing the patient’s affection.
  5. The combination of lithium with some antipsychotics is probably the most effective therapeutic combination to treat manic episodes.
  6. The combination of lithium and antipsychotics to treat hippomanic episodes is also effective; however, because of the lower severity of these episodes, it is often not necessary to add antipsychotics to lithium treatment.
  7. Despite being a suitable drug to treat mixed episodes, its effectiveness is somewhat reduced when compared to the effect it causes in the treatment of manic or hippomanic episodes.
  8. The efficacy of lithium to treat depression episodes is much lower than for treating episodes of mania or hypomania.
  9. Lithium is used to treat depressive episodes of bipolar disorder but is usually more expendable to treat depressive episodes of depression.
  10. Lithium is a medicine suitable for the maintenance treatment of bipolar disorder.

Depression and Bipolar Disorder

Depression and bipolar disorder are two mental illnesses that are part of the same diagnostic group; however, they are rarely interpreted as similar disorders.

In fact, depression is often interpreted as a fairly common psychological disorder, while bipolar disorder is often seen as a rather extravagant mental disorder.

However, the differences between the two disorders are not so conspicuous and both constitute an alteration of mood.

Depression

For its part, depression is characterized by the suffering of depressive episodes that modify the mood of the person.

The suffering of this type of episodes is determined by presenting a depressive mood, and a loss of interest and / or a decrease in the capacity to experience pleasure.

Likewise, during the depressive episode the person usually experiences sadness, vague physical complaints, alterations of the appetite, of the dream and of the libido, difficulties to concentrate, agitation or psychomotor slowing.

Finally, the thinking becomes pessimistic and can be impregnated with ideas of handicap and guilt. Ideas of death or suicide may also arise.

Thus, the diagnosis of depression is made by connoting the presence of at least one depressive episode like the one just discussed.

Bipolar disorder

In bipolar disorder, unlike depression, a greater number of different episodes may be experienced.

Firstly, it should be noted that in this disorder one can experience exactly the same depressive episode that is experienced in depression, so that the similarities between the two alterations are immediately apparent.

However, bipolar disorder and depression also differ in many other characteristics.

These characteristics are mainly based on the fact that in bipolar disorder not only are experienced depressive episodes, but also have to present other types of episodes.

One of them is the mania episode. This episode is defined by a period of time equal to or greater than one week in which an abnormal and persistently elevated mood occurs.

In mania, there are states of euphoria, constant expansiveness and recurrent moments of irritability.

Also, symptoms such as excessive self-esteem, grandiosity, decreased sleep, verbiage, brain drain, distraction or disinhibition often appear frequently.

Thus, mania would be an episode in contrast to depression, where instead of a decrease in mood, it rises above normal.

Another episode that can occur in bipolar disorder is hypomania.

The clinic of these episodes is identical to that explained in the manic episodes but it presents in a lower intensity and does not usually cause a clear deterioration in the person who suffers it.

Also Read: Depression in Older and Older Adults

Finally, the last episode that may appear is the mixed episode, which is characterized by the simultaneous appearance of manic symptomatology and depressive symptomatology.

Differences and similarities between depression and bipolar disorder

Thus, when we relate depression to bipolar disorder we can state the following conclusions.

  • In both disorders there is an alteration of mood.
  • Both disorders may present with depressive episodes.
  • Bipolar disorder differs from depression by the presence of manic, hippomanic or mixed episodes with symptoms opposite to those presented in depression.
  • Both disorders require a stabilization of the mood to return an optimum affective functioning.

Thus, it is not surprising that a drug that manages to stimulate mood, such as lithium, becomes a suitable drug to treat this type of psychological alterations.

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