Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 16;12(1):35.
doi: 10.1186/s40345-024-00356-5.

Relevance of red blood cell Lithium concentration in the management of Lithium-treated bipolar and unipolar disorders: a systematic narrative review

Manon Coyac  1   2   3 , Lynn Jalabert  4 , Xavier Declèves  5   6   7 , Bruno Etain  5   4   6 , Frank Bellivier  5   4   6
Affiliations

Relevance of red blood cell Lithium concentration in the management of Lithium-treated bipolar and unipolar disorders: a systematic narrative review

Manon Coyac et al. Int J Bipolar Disord. .

Abstract

Background: Despite a variability in response and a narrow therapeutic index, Lithium (Li) remains the gold standard treatment for bipolar disorders (BD), and a treatment of choice for unipolar disorders (UD). Red blood cell Li concentration (RBCLiC) and red blood cell/plasma Li ratio (LiR) have been studied in many areas of mood disorders (such as acute or chronic Li efficacy, adherence, side effects (SE), intoxication management) as well as in several research domains. This systematic review aims to synthesize the existing literature.

Methods: We conducted a systematic review, based on preferred reporting items for systematic reviews and Metanalysis (PRISMA) guidelines, of articles published between 1972 and February 2023, indexed in the following databases: EMBASE, MEDLINE, Cochrane Library. The search terms were combinations of the following headings: "Lithium AND Plasma AND Erythrocyte AND Mood disorders". The systematic review protocol was published to PROSPERO (CRD42023406154).

Results and conclusion: Out of the 252 identified studies, 57 met the selection criteria. The articles investigated the interest of RBCLiC and other blood parameters (PLiC and LiR) in various areas: (i) disease management (31 articles) (compliance/adherence (5 articles), SE/toxicity (13 articles), prediction of Li response/therapeutic efficacy for acute episode or for relapse prevention (17 articles)), (ii) Li blood parameters as trait markers of mood disorders subtypes (UD, BDI, BDII) (16 articles), (iii) Li blood parameters as state markers of mood episodes (11 articles), (iv) factors influencing Li blood parameters (age, gender, ethnicity, dosage and duration of Li treatment, co-medications with other treatments, seasonality) associated with RBCLiC or LiR (24 articles), and (v) potential pathophysiological mechanisms (30 articles).

Conclusion: Overall, this review suggests that RBCLiC or LiR could be of interest for tolerance monitoring. However, the heterogeneity of methods and results, coupled with the limited amount of data, does not allow clear conclusions to be drawn in the other areas explored in this literature review. Given the potential interest in exploring brain Li pharmacokinetics (PK)s, this review calls for further research.

Keywords: Lithium; Mood disorders; Plasma Lithium concentration; Red blood cell Lithium concentration; Red blood cell-to-plasma Lithium ratio.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Number of publications per decade (Total = 57)
Fig. 3
Fig. 3
Summary of the RBCLiC, LiR, and PLiC areas of interest explored in this systematic literature review
See this image and copyright information in PMC

References

    1. Ahmadi-Abhari SA, Dehpour AR, Emamian ES, Azizabadi-Farahani M, Farsam H, Samini M, Shokri J. The effect of concurrent administration of psychotropic drugs and lithium on lithium ratio in bipolar patients. Hum Psychopharmacol. 1998;13(1):29–34. 10.1002/(SICI)1099-1077(199801)13:1%3c29::AID-HUP940%3e3.0.CO;2-T.
    1. Ahmadi-Abhari S-A, Ghaeli P, Fahimi F, Esfahanian F, Farsam H, Dehpour AR, Jahanzad I, Hatmi Z-N, Dashti S. Risk factors of thyroid abnormalities in bipolar patients receiving lithium: a case control study. BMC Psychiatry. 2003. 10.1186/1471-244X-3-4. - PMC - PubMed
    1. Ahmadi-Abhari SA, Farhoodian A, Noroozian M, Ghaeli P, Dashti-Khavidaki S, Sadeghi M, Dehpour A-R, Fahimi F. Lithium erythrocyte concentration and neurological toxicity in bipolar disorder. J Pharm Pract Res. 2005;35(2):103–5. 10.1002/j.2055-2335.2005.tb00316.x.
    1. Amasheh S, Meiri N, Gitter AH, Schöneberg T, Mankertz J, Schulzke JD, Fromm M. Claudin-2 expression induces cation-selective channels in tight junctions of epithelial cells. J Cell Sci. 2002;115(Pt 24):4969–76. 10.1242/jcs.00165. - PubMed
    1. Azizabadi-Farahani M, Mirazi N, Azar M, Farsam H, Dehpour AR. The effect of concomitant use of neuroleptic drugs and lithium on the erythrocyte/plasma lithium ratio in iranian patients with bipolar disorder. J Clin Pharm Ther. 1996;21(1):3–7. - PubMed

LinkOut - more resources