Why lithium remains the gold standard for treating bipolar disorder — Live Science
Lithium, used to treat bipolar disorder since 1949, is still considered the gold standard for treating this condition. It can help control manic and depressive episodes and prevent their recurrence, although doctors have not yet established the drug’s exact mechanism of action in the brain, Live Science reports.
Bipolar disorder is a long-term condition accompanied by pronounced changes in mood and energy levels. People with this diagnosis may experience manic, hypomanic and depressive episodes. Mania can manifest as an elevated mood, excessive energy, strong motivation and a tendency toward hedonistic and risky behavior.
Effects on both poles of the disorder
Treating bipolar disorder requires balance, as an intervention aimed at one emotional state may affect the other. In particular, antidepressants without anti-manic therapy can trigger mania or destabilize the course of the illness. Combinations of antidepressants, antipsychotics and anticonvulsant drugs that stabilize mood may also be prescribed to control symptoms.
Lithium stands out because it can be useful during both depressive and manic states. Specialists cite the prevention of relapses — the return of both types of episodes — as its main advantage.
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How lithium may work
The drug is usually prescribed as lithium carbonate in tablets or lithium citrate in liquid form. In the body, these compounds form lithium ions. Due to its small size, the ion can enter brain cells, unlike many other drugs that act mainly on cell surfaces.
Lithium interacts with many cellular processes. It may affect neurotransmitter systems, including dopamine and serotonin, whose regulation is disrupted in bipolar disorder. The lithium ion also blocks the enzyme glycogen synthase kinase-3, which is associated with regulating gene activity, circadian rhythms, inflammation and cell survival. Specialists also link its effects to autophagy, antioxidant action and support for mitochondrial function.
The need for careful monitoring
About one-third of patients have a pronounced response to lithium, around one-third have an intermediate response, and another approximately one-third do not respond to therapy. Determining the drug’s long-term effectiveness can be difficult, as assessing the prevention of recurrent episodes may take years.
Lithium has a narrow therapeutic range: the difference between an effective and toxic dose is small. High doses can be toxic to the kidneys and thyroid gland, while possible side effects include more frequent urination and mild tremor. Therefore, treatment requires careful and proper medical management.
