ANTIMANIC MOOD-STABILIZING AGENTS: LITHIUM
Evidence for the safety and the efficacy of lithium salts in the treatment of mania and the prevention of recurrent attacks of bipolar manic-depressive illness is both abundant and convincing. However, the limitations and adverse effects of lithium salts have become increasingly well appreciated, and efforts to find alternative antimanic or mood-stabilizing agents have intensified. The most successful alternatives or adjuncts to lithium to date are the anticonvulsants carbamazepine, lamotrigine, and valproic acid.
Lithium is the lightest of the alkali metals (group Ia); the salts of this monovalent cation share some characteristics with those of Na+ and K+. Traces of the ion occur normally in animal tissues, but Li+ has no known physiological role. In the U.S., the drug forms are the salts, lithium carbonate and lithium citrate. Therapeutic concentrations of Li+ have almost no discernible psychotropic effects in normal individuals. Li+ is not a sedative, depressant, or euphoriant, characteristics that differentiate it from other psychotropic agents. The precise mechanism of action of Li+ as a mood-stabilizing agent remains unknown.
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