Therapeutic Application of Lithium in Bipolar Disorders: A Brief Review

Abstract

Bipolar affective disorder includes Bipolar Disease (BD) and Bipolar Spectrum Disorder (BSD). The prevalence of BSD, BD-I, BD-II, and subthreshold BD globally is estimated to be about 3.1%, 1.5%,0.03%, and 1.6%, respectively. BD is a multidimensional disease that exhibits a range of moods of mania, hypomania, and depression. The disease is chronic, complex, and fatal, with a high possibility of reappearance, infirmity, social incompetence, and felo-de-se. Managing emotional disruption, negative neuropsychology, physiology, and immunology is a challenge. This review focuses on therapeutic benefits, adverse drug reactions, and pharmacological intervention for BD and BSD, in particular lithium. Long-term management of BD with a single medication is ineffective and therefore, not recommended. It is advised to use multiple agents for treatment instead. Medications include mood stabilizers (lithium and anticonvulsants), atypical antipsychotics, and antidepressants. Along with medication provision, psychotherapy is of great significance for BD patients. The review was conducted on recent available scientific literature through the electronic database like Embase, ScienceDirect, Google Scholar, and PubMed using keywords like 'Bipolar Disease,' 'Bipolar Disease Therapeutics,' 'Bipolar Disease and Psychotherapy' to highlight the possible effective means of management of this disease of mood instability.

Keywords: bipolar disorders; bipolar spectrum disorder; fda-approved medications; history of bipolar disorders; intervention; lithium; narrative review; nhs approved medications; pharmacological treatment; treatment modalities.

Figure 1. Multimodal Treatment Strategies In Bipolar Disorders.

Image Credit: Siddhartha Dutta.

Figure 2. Illustration of Lithium Blocking the Breakdown of Inositol Monophosphate to Inositol.

The breakdown of inositol mono phosphate to inositol results in a decrease in free inositol and a subsequent decrease of phosphatidylinositol (PIP2). Image Credit: Rahnuma Ahmad Pl C: Phospholipase C, IP3: Phosphatidyl Inositol triphosphate, DAG: Diacyl Glycerol, IP: Inositol Mono Phosphate, PIP: Phosphatidyl Inositol Phosphate, PIP2: Phosphatidyl Inositol Bis Phosphate.

Figure 3. The Effects of Lithium on Brain.

This image is depicting the effects of Lithium on the brain including the Prefrontal Cortex, Cingulate Gyrus, Amygdala, Hippocampus, Habenula. Image Credit: Rahnuma Ahmad.

Figure 4. Summary of Effects and Adverse Drug Reactions of Lithium.

Image Credit: Siddhartha Dutta. BDNF and Bcl-2 are neuroprotective proteins.

Figure 5. Lithium Versus Antipsychotics in Bipolar Disorder.

BD: Bipolar disorder Image Credit: Susmita Sinha.

Figure 6. Schematic Diagram Showing Effects of Various Therapies in Bipolar Mood Disorder.

Image Credit: Susmita Sinha.