Lithium salts are chemical salts of lithium used primarily in the treatment of bipolar disorder as mood stabilizing drugs. They are also sometimes used to treat depression and mania. Lithium carbonate (Li₂CO₃), sold as Carbolith®, Cibalith-S®, Duralith®, Eskalith®, Lithane®, Lithizine®, Lithobid®, Lithonate® and Lithotabs®, is the most commonly prescribed, whilst the citrate salt lithium citrate (Li₃C₆H₅O₇), the sulfate salt lithium sulfate (Li₂SO₄), the oxybutyrate salt lithium oxybutyrate (C₄H₉LiO₃) , aspartateand the orotate salt lithium orotate are alternatives. A magnified crystal of a salt (halite/sodium chloride) In chemistry, a salt is any ionic compound composed of positively charged cations and negatively charged anions, so that the product is neutral and without a net charge. ... General Name, Symbol, Number lithium, Li, 3 Chemical series alkali metals Group, Period, Block 1, 2, s Appearance silvery white/gray Atomic mass 6. ... Bipolar disorder, often referred to colloquially as manic depression, is a diagnosis describing low (clinically depressed) and high (manic or hypomanic) mood swings significantly broad enough to interfere with an individuals ability to function on a daily basis. ... A mood stabilizer is a psychiatric medication used in the treatment mood disorders characterised by rapid and unstable mood shifts. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... Clinical depression is a state of sadness or melancholia that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... This article is about the medical condition. ... Chemical strucutre of citric acid. ... In inorganic chemistry, a sulfate (IUPAC-recommended spelling; also sulphate in British English) is a polyatomic anion or a compound containing this group. ... Aspartic acid, also known as aspartate, the name of its anion, is one of the 20 natural proteinogenic amino acids which are the building blocks of proteins. ... The introduction of this article does not provide enough context for readers unfamiliar with the subject. ... This article needs to be cleaned up to conform to a higher standard of quality. ...

Lithium is widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing noradrenaline release and increasing serotonin synthesis. A diagram showing the CNS: 1. ... Norepinephrine, known as noradrenaline outside the USA, is a catecholamine and a phenethylamine with chemical formula C8H11NO3. ... Serotonin (5-hydroxytryptamine, or 5-HT) is a monoamine neurotransmitter synthesised in serotonergic neurons in the central nervous system and enterochromaffin cells in the gastrointestinal tract. ...

History

The use of lithium salts to treat mania was first proposed by the Australian psychiatrist John Cade in 1949, after he discovered the effect of first lithium urate, and then other lithium salts, on animals. Cade soon succeeded in controlling mania in chronically hospitalized patients. This was the first successful application of a drug to treat mental illness, and opened the door for the development of medicines for other mental problems in the next decades. Dr John Frederick Joseph Cade AO (1912-1980) was an Australian psychiatrist credited with discovering (in 1948) the effects of lithium carbonate as a mood stabilizer in the treatment of Bipolar Disorder (then known as Maniac Depression). ... 1949 (MCMXLIX) is a common year starting on Saturday. ...

The rest of the world was slow to adopt this revolutionary treatment, largely because of deaths which resulted from even relatively minor overdosing, and from use of lithium chloride as a substitute for table salt. Largely through the research and other efforts of Denmark's Mogens Schou in Europe, and Samuel Gershon in the U.S., this resistance was slowly overcome. The application of lithium for manic illness was approved by the United States Food and Drug Administration in 1970. The Food and Drug Administration (FDA) of the United States is the government agency responsible for regulating food (human and animal), dietary supplements, drugs (human and animal), cosmetics, medical devices (human and animal), biologics, and blood products in the United States. ...

Treatment

Lithium treatment is used to treat mania in bipolar disorder. Initially, lithium is often used in conjunction with antipsychotic drugs as it can take up to a week for lithium to have an effect. Lithium is also used as prophylaxis for depression and mania in bipolar disorder. Also, it is sometimes used for other disorders, like cycloid psychosis, unipolar depression, migraine and others. It is sometimes used as an "augmenting" agent, to increase the benefits of standard drugs used for unipolar depression. Lithium treatment is generally considered to be unsuitable for children. This article is about the medical condition. ... Bipolar disorder, often referred to colloquially as manic depression, is a diagnosis describing low (clinically depressed) and high (manic or hypomanic) mood swings significantly broad enough to interfere with an individuals ability to function on a daily basis. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ... Sad redirects here; for the three letter acronym, see SAD, or for the Quranic sura see Sad Depression, or, more properly, a depressed mood, refers to a state of non-clinical melancholia that is shorter than 2 weeks in duration and distinctly differentiated from a diagnosis of clinical depression. ...

Mechanism of Action

The precise mechanism of action of Li⁺ as a mood-stabilizing agent is currently unknown, but it is possible that Li⁺ produces its effects by interacting with the transport of monovalent or divalent cations in neurons. However, because it is a poor substrate at the sodium pump, it cannot maintain a membrane potential and only sustains a small gradient across biological membranes. Yet Li⁺ is similar enough to Na⁺ in that under experimental conditions, Li⁺ can replace Na⁺ for production of a single action potential in neurons. An ion is an atom or group of atoms with a net electric charge. ... Neurons (also called nerve cells) are the primary cells of the nervous system. ... Simplified Diagram of the sodium pump Na+/K+-ATPase (also known as the Na+/K+ pump or Na+/K+ exchanger) is an enzyme (EC 3. ... Membrane potential (or transmembrane potential or transmembrane potential difference or transmembrane potential gradient), is the electrical potential difference (voltage) across a cells plasma membrane. ... A biological membrane or biomembrane is a membrane which acts as a barrier within or around a cell. ... A. A schematic view of an idealized action potential illustrates its various phases as the action potential passes a point on a cell membrane. ... Neurons (also called nerve cells) are the primary cells of the nervous system. ...

Unlike other psychoactive drugs, Li⁺ produces no obvious psychotropic effects, (such as sedation, depression, euphoria) in normal individuals at therapeutic concentrations. Wikipedia does not yet have an article with this exact name. ... Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... Look up depression in Wiktionary, the free dictionary. ... Euphoria may refer to: A psychological state of intense good feeling, see happiness Euphoria, a pop/dance music act from the 1990s Euphoria, a psychedelic music group Euphoria, an album by Leftover Salmon Euphoria, an album by Def Leppard Euphoria programming language Euphoria, a movie directed by Brad Armstrong (Euphoria...

Lithium toxicity and side effects

Those who use lithium should receive regular blood tests and should monitor the thyroid and kidney for toxic damage. As it interferes with the regulation of sodium and water levels in the body, lithium can cause dehydration. Dehydration, which is compounded by heat, can result in increasing lithium levels. Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Human kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Atomic mass 22. ... Dehydration is the removal of water (hydor in ancient Greek) from an object. ... In physics, heat is defined as energy in transit. ...

High doses of haloperidol, fluphenazine, or flupenthixol may be hazardous when used with lithium; irreversible toxic encephalopathy has been reported. Haloperidol (sold as Aloperidin®, Bioperidolo®, Brotopon®, Dozic®, Einalon S®, Eukystol®, Haldol®, Halosten®, Keselan®, Linton®, Peluces®, Serenace®, Serenase®, Sigaperidol®) is a conventional butyrophenone antipsychotic drug. ... Fluphenazineis a typical antipsychoticdrug. ... Flupentixol is a synthetic compound that acts on a subset of dopamine receptors. ... Encephalopathy is a container term for various conditions affecting the brain. ...

Lithium salts, with the possible exception of lithium orotate, have a narrow therapeutic/toxic ratio and should therefore not be prescribed unless facilities for monitoring plasma concentrations are available. Patients should be carefully selected. Doses are adjusted to achieve plasma concentrations of 0.6 to 1.2mmol Li⁺/litre (lower end of the range for maintenance therapy and elderly patients) on samples taken 12 hours after the preceding dose. Overdosage, usually with plasma concentrations over 1.5mmol Li⁺/litre, may be fatal and toxic effects include tremor, ataxia, dysarthria, nystagmus, renal impairment, and convulsions. If these potentially hazardous signs occur, treatment should be stopped, plasma lithium concentrations redetermined, and steps taken to reverse lithium toxicity. This article needs to be cleaned up to conform to a higher standard of quality. ... Therapeutic drug monitoring is a branch of clinical chemistry that specialises in the measurement of medication levels in blood. ... For other uses, see Tremor (disambiguation). ... Ataxia (from Greek ataxiā, meaning failure to put in order) is unsteady and clumsy motion of the limbs or trunk due to a failure of the gross coordination of muscle movements. ... Dysarthria (from new latin dys-, prefix meaning mis-, dis-, accidental + greek -arthro, joint) is an injury or symptom describing minor speech impediments, often slurred speech. ... Look up Nystagmus in Wiktionary, the free dictionary Nystagmus is rapid involuntary rhythmic eye movement, with the eyes moving quickly in one direction (quick phase), and then slowly in the other (slow phase). ...

Lithium toxicity is compounded by sodium depletion. Concurrent use of diuretics that inhibit the uptake of sodium by the distal tubule (e.g. thiazides) is hazardous and should be avoided. In mild cases withdrawal of lithium and administration of generous amounts of sodium and fluid will reverse the toxicity. Plasma concentrations in excess of 2.5 mmol Li⁺/litre are usually associated with serious toxicity requiring emergency treatment. When toxic concentrations are reached there may be a delay of 1 or 2 days before maximum toxicity occurs. General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Atomic mass 22. ... A diuretic is any drug that elevates the rate of bodily urine excretion (diuresis). ... Kidney nephron The distal convoluted tubule (DCT) is a portion of kidney nephron between the loop of Henle and the collecting duct system. ... Thiazides are a class of drug that promote water loss from the body ((diuretics)). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. ...

In long-term use, therapeutic concentrations of lithium have been thought to cause histological and functional changes in the kidney. The significance of such changes is not clear but is of sufficient concern to discourage long-term use of lithium unless it is definitely indicated. An important consequence is the development of diabetes insipidus (inability to concentrate urine). Patients should therefore be maintained on lithium treatment after 3-5 years only if, on assessment, benefit persists. Conventional and sustained-release tablets are available. Preparations vary widely in bioavailability, and a change in the formulation used requires the same precautions as initiation of treatment. There are few reasons to prefer any one simple salt of lithium; the carbonate has been the more widely used, but the citrate is also available. Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced. ... In pharmacology, bioavailability is used to describe the fraction of an administered dose of medication that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. ...

Lithium overdose

Signs that lithium levels within the body are too high include: confusion, diarrhea, lethargy, severe tremors, and/or an upset stomach. Look up Confusion in Wiktionary, the free dictionary Confusion can have the following meanings: Unclarity or puzzlement, e. ... Diarrhea (American English) or diarrhoea (Commonwealth English) is a condition in which the sufferer has frequent and watery, chunky, or loose bowel movements (from the ancient Greek word διαρροή = leakage; lit. ... Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ... For other uses, see Tremor (disambiguation). ... -1...

Lithium and culture

As with many other drugs, songs have been written about its effects, "Lithium Sunset" by Sting and "Lithium" by Nirvana among others. A song is a relatively short musical composition for the human voice (possibly accompanied by other musical instruments), which features words (lyrics). ... Sting circa 1987 Gordon Matthew Sumner, CBE (born October 2, 1951), best known by his stage name Sting, is an English musician and formerly bassist and lead singer of The Police. ... Lithium is a song by the grunge band Nirvana. ... This article is about the grunge band Nirvana. ...

The soft drink 7 Up, originally named "Bib-Label Lithiated Lemon-Lime Soda", contained lithium citrate until it was reformulated in 1950. This article is about a soft drink. ...

Hundreds of other soft drinks also included lithium salts or lithia waters as well as at least one brewery which produced Lithia beers (all of these were forced to remove lithium in 1948).

An early version of Coca Cola available in pharmacies' soda fountains called Lithia Coke was a mixture of Coca Cola syrup and litha water (lithia waters are naturally occurring mineral waters with higher lithium amounts).

The amount of lithium in any of the commercially available soft drinks was hundreds of times less than a minimum psychiatric dose but the ban didn't make any distinctions on that basis.

Selected bibliography

• McIntyre RS, Mancini DA, Parikh S, Kennedy SH. "Lithium revisited." Can J Psychiatry. 2001 May;46(4):322-7.
• Bowden CL, Brugger AM, Swann AC, Calabrese JR, Janicak PG, Petty F, and others. Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 1994;271:918–24.

External links

• "Lithium revisited"
• 7-UP and lithium
• http://www.psycheducation.org/depression/meds/moodstabilizers.htm
• http://www.psycheducation.org/depression/meds/lithium.html
• SID 685039 -- PubChem Substance Summary (Lithium Oxybutyrate)