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.
Thus, only with the first approximation about what is lithium and we see clearly that its mechanism of action is to stabilize the mood, That is to say, to ensure that affection is neither excessively high nor excessively low.
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 that remains most strongly today is that lithium alters the G-proteins and their ability to send signals Within 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 the 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 Symptoms that occur in this disease.
Thus, the drugs most commonly used to treat depressive episodes of depression are heterocyclic antidepressants (such as impipramine), Antidepressants SSRIs (Such as paroxetine) and new antidepressants (such as mirtazapine).
This fact would be explained by the fact that antidepressants have a more direct effect on the elevation of mood. While lithium allows Is to stabilize (increase or reduce) the mood, the antidepressants manage to raise 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 acquires much more Importance and becomes a vital drug for your treatment.
This effect is explained by the characteristics of the 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.
Thus, it is generally not advisable to use Antidepressants During these phases as these can raise the mood quickly and cause the Appearance of a maniac episode immediately.
Thus, in these cases, lithium becomes the drug of first choice, since this, although it will raise the mood in a more Slow and less effective than the antidepressant, will prevent the occurrence of a manic episode.
Lithium to Treat Bipolar Disorder
The pharmacological treatment of bipolar disorder continues to be a challenge for psychiatrists today, since each stage of the disease usually Require a different therapeutic approach.
However, during the last 50 years, there have been some changes in trends in the use of different drugs available to treat This type of psychopathological alteration.
In this sense, lithium has been, and continues to be, the drug par excellence for bipolar disorder. In fact, in the 1950s and 1960s I had Acceptance in Europe and is still maintained today.
Recently, the Collegial Medical Organization and the Ministry of Health and Consumer Affairs have produced a manual of action in the case of mania that includes the Evidences 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, ie in those cases where symptoms Maniacs are expressed autonomously.
Thus, the study demonstrated how in controlled and randomized trials of this type of psychopathologies, lithium achieved a good response Pharmacological treatment in almost all cases.
However, in this same study, lithium only achieved limited evidence on its effectiveness in treating cases of mixed mania, that is, for Intervene in those episodes that present depressive symptoms and manic symptoms simultaneously.
In these cases, other drugs such as Valproate wave Carbamazepine , Demonstrated greater treatment efficacy.
Thus, lithium has been shown to be more effective in the treatment of manic episodes than in the treatment of mixed episodes. The diagnosis of these characteristics of bipolar disorder becomes very important when specifying the therapeutic plan.
As regards the hypomanic phases, it has been shown that lithium is an effective drug to attenuate its symptoms, to stabilize the mood and To recover an optimum operation.
This fact was confirmed by a retrospective study by Tono on the efficacy of lithium to reverse the hypomanic phases in A total of 129 people with type II bipolar disorder.
In addition, in this same study we studied the effects of lithium to treat manic symptoms presented in a total of 188 individuals Diagnosed with type I bipolar disorder.
In this second Tono review, it was found that the efficacy of lithium was more effective in treating hyperthymic symptoms (manic episodes and episodes Hypomanic) than to treat hypothymic 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 Symptoms of bipolar disorder.
More specifically, in the manual developed by the Medical School Organization and the Ministry of Health and Consumer Affairs , It was found that Haloperidol, Risperidone, Olanzapine, Quetiapine and Arpiprazole are optimal medications to accompany a treatment with lithium.
Finally, it should be noted that, as demonstrated by Goodwin and Jamison in 1990, lithium is a drug suitable for maintenance treatment of Bipolar disorder as it reduces the frequency, duration and intensity of manic, hypomanic and depressive episodes.
Thus, we can draw the following conclusions about the efficacy of lithium for bipolar disorder:
Lithium is the drug most commonly used to treat bipolar disorders.
Together with other mood stabilizers like Carbamazepine or Valproic Acid is the first choice treatment.
Lithium is used more frequently than Carbamazepine and Valproic Acid to demonstrate higher rates of efficacy in treatment Of bipolar disorder.
Lithium is especially effective in treating the manic and hypomanic symptoms of bipolar disorder and achieving a decrease in the state of Mood stabilizing the affection of the patient.
The combination of lithium and some antipsychotics is probably the most effective therapeutic combination for treating manic episodes.
The combination of lithium and antipsychotics to treat hypomanic episodes is also effective, however, because of the lower severity of these Episodes it is often not necessary to add antipsychotics to treatment with lithium.
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 hypomanic episodes.
The efficacy of lithium to treat depression episodes is significantly lower than for treating episodes of mania or hypomania.
Lithium is used to treat depressive episodes of bipolar disorder but is usually more expendable to treat episodes Depressive symptoms of depression.
Lithium is a drug 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 Disorders.
In fact, depression is often interpreted as a fairly common psychological disorder, while bipolar disorder is often seen as a Rather more extravagant mental disorder.
However, the differences between the two disorders are not so conspicuous and both constitute an alteration of the State of mind .
Depression
On the other hand, the 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 Ability 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, Difficulty concentrating , Psychomotor agitation or slowing down.
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 can be experienced.
First, it should be noted that in this disorder one can experience exactly the same depressive episode that is experienced in depression, for 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 Episode of mania . This episode is defined by a period of time equal to or greater than one week in which a state of Abnormal and persistently high mood.
In mania, there are states of euphoria, constant expansiveness and recurrent moments of irritability.
Likewise, symptoms such as excessive self-esteem, grandiosity, decreased sleep, verbiage, Flight of ideas , Distraction or Disinhibition often appear frequently.
Thus, mania would be an episode in contrast to depression, where instead of a decrease in mood, it is elevated by Above normal.
Another episode that can occur in bipolar disorder is hypomania.
The clinical of these episodes is identical to the one explained in manic episodes but is presented in a lower intensity and does not usually provoke a clear Deterioration in the person who suffers it.
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 an alteration of the mood is present.
Both disorders may present with depressive episodes.
Bipolar disorder differs from depression because of the presence of manic, hypomanic, or mixed episodes with symptoms 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 chemotate such as lithium, becomes a suitable drug to treat This type of psychological alterations.
References
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