Lithium in Bipolar Disorder
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Clin Pharmacokinet 2002; 41 (9): 639-660 0312-5963/02/0009-0639/$25.00/0 © Adis International Limited. All rights reserved.
Lithium in Bipolar Disorder Can Drug Concentrations Predict Therapeutic Effect? Beth Sproule Centre for Addiction and Mental Health, Toronto, and Faculty of Pharmacy and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Acute Mania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Acute Bipolar Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Prophylactic Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Lithium Treatment of Bipolar Disorder in Special Populations . . . . . . . . 4.1 Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Issues in Monitoring Serum Lithium Concentrations for Therapeutic Effect 5.1 Factors Affecting the 12-Hour Serum Lithium Concentration . . . . . 5.1.1 Time Since Last Dose . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.2 Daily Lithium Schedule . . . . . . . . . . . . . . . . . . . . . . . . 5.1.3 Patient Compliance . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.4 Diurnal Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.5 Lithium Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.6 Other Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1.7 Effect on Interpretation of Concentrations . . . . . . . . . . . . 5.2 Lithium Concentrations in the Brain . . . . . . . . . . . . . . . . . . . 5.3 Lithium Pharmacokinetic Changes Based on Clinical Mood State . 5.4 Heterogeneity in Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . 5.5 Degree of Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abstract
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The evidence is reviewed for effective serum lithium concentrations for the acute and prophylactic treatment of mania and depression in patients with bipolar disorder. The efficacy of lithium in the treatment of acute manic episodes has been recognised for several decades, primarily using concentrations in the range of 0.8 to 2 mmol/L
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