The efficacy of Li in bipolar disorder
R Lozano,1 R Marín,2 MJ Santacruz,2 I Freire,2 R Gomez2
1Department of Pharmacy, 2Department of Psychiatry, Hospital Real Nuestra Señora de Gracia, Zaragoza, Spain
The efficacy of lithium (Li) for acute mania and as prophylaxis against recurrent episodes of mania in bipolar disorder has been well established, with the minimum effective Li serum concentration for acute mania in the range of 0.6–1.2 mEq/L, although lower maintenance concentrations can prove effective in some patients.1–5
Thyroid disorders are also associated with alterations in mood, and patients with hypothyroidism may present with depression and cognitive dysfunction,6–8 while patients with hyperthyroidism may present with anxiety, depression, mood lability,7,9 and manic symptoms.10 However, considering that overt hyperthyroidism is uncommon in bipolar disorder, with a prevalence ≤2% across different studies,11,12 this has been largely attributed to lithium,13 with rates varying from 0 to 47% (average of about 10%) among patients on long-term treatment with lithium.13–16
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