Are serum lithium levels related to the polarity of recurrence in bipolar disorders? Evidence from a multicenter trial.

Full Abstract

The primary objective is to test whether the polarity of recurrence (depressive vs manic or mixed), is related to lithium levels. A total of 86 euthymic bipolar patients (DSM-IV) on lithium monotherapy were prospectively followed up for 2.5 years with regular monitoring of both lithium levels and psychopathology. The last lithium level during the free interval that preceded worsening of affective symptoms was related to polarity of symptoms. To account for effects of major confounders, results were corroborated by multivariate analysis. An intervention for manic or mixed symptomatology was required in 27 patients, whereas 22 patients were treated for depressive symptoms. Average lithium levels preceding reappearance of manic or mixed symptomatology were lower than levels preceding reappearance of depressive symptoms (0.53+/-0.13 vs 0.66+/-0.21 mmol/l, P=0.01). This result was confirmed using logistic regression analyses with type of index episode, diagnostic subtype and residual manic and depressive symptoms as covariates. The results indicate that manic or mixed recurrences might rather occur at lower lithium levels, whereas the depressive pole prevails in the higher range. If substantiated by further studies, this finding might indicate that higher lithium levels are needed to prevent manic episodes than to prevent depressive episodes.

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Author information

Author/s: Kleindienst, Nikolaus (N); Severus, Wolfram Emanuel (WE); Greil, Waldemar (W);

Affiliation: Department of Psychiatry, University of Munich, Munich, Germany. nikolaus.kleindienst(-atsign-)zi-mannheim.de

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial

Journal: International clinical psychopharmacology (Int Clin Psychopharmacol), published in England. (Language: eng)

Reference: 2007-May; vol 22 (issue 3) : pp 125-31

Dates: Created 2007/04/06; Completed 2007/07/16;

PMID: 17414737, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Anticonvulsants - administration & dosage; adverse effects; pharmacokinetics
Antimanic Agents - adverse effects; pharmacokinetics
Bipolar Disorder - blood; chemically induced; drug therapy
Carbamazepine - administration & dosage; adverse effects; pharmacokinetics
Dose-Response Relationship, Drug
Female
Humans

Humans
Lithium Carbonate - administration & dosage; adverse effects; pharmacokinetics
Male
Middle Aged
Multivariate Analysis
Psychiatric Status Rating Scales
Recurrence - prevention & control
Risk Factors

Associated Chemicals: Anticonvulsants (0) ; Antimanic Agents (0) ; Carbamazepine (298-46-4) ; Lithium Carbonate (554-13-2)

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