The use of Lithium as a treatment of Bipolar Disorder was first
discovered by Dr. John Cade.
Lithium salts have long been used as a first-line treatment for
bipolar disorder. The therapeutic effect of lithium salts appears
to be entirely due to the lithium ion, Li+. Approved for the
treatment of acute mania in 1970 by the U.S. Food and Drug
Administration (FDA), lithium has been an effective
mood-stabilizing medication for many people with bipolar disorder.
Lithium is also noted for reducing the risk of suicide in major
affective disorders, such as bipolar disorder: suicide risk on the
whole drops to below the average level for society (Baldessarini,
2003).
The mechanism of lithium salt treatment is believed to work as
follows: some symptoms of bipolar disorder appear to be caused by
the enzyme inositol monophosphatase (IMPase), an enzyme that splits
inositol monophosphate into free inositol and phosphate. It is
involved in signal transduction and is believed to create an
imbalance in neurotransmitters in bipolar patients. The lithium ion
is believed to produce a mood stabilizing effect by inhibiting
IMPase by substituting for one of two magnesium ions in IMPase's
active site, slowing down this enzyme.
Anticonvulsant mood stabilizers
Anticonvulsant medications, particularly valproate and
carbamazepine, have been used as alternatives to lithium in many
cases. Valproate was FDA approved for the treatment of acute mania
in 1995. Newer anticonvulsant medications, including lamotrigine,
gabapentin, and topiramate, are being studied to determine their
efficacy as mood stabilizers in bipolar disorder. Some research
suggests that different combinations of lithium and anticonvulsants
may be helpful.
According to studies conducted in Finland in patients with
epilepsy, valproate may increase testosterone levels in teenage
girls and produce polycystic ovary syndrome in women who began
taking the medication before age 20. Increased testosterone can
lead to polycystic ovary syndrome with irregular or absent menses,
obesity, and abnormal growth of hair. Therefore, young female
patients taking valproate should be monitored carefully by a
physician.
During a depressive episode, people with bipolar disorder commonly
require additional treatment with antidepressant medication.
Typically, lithium or anticonvulsant mood stabilizers are
prescribed along with an antidepressant to protect against a switch
into mania or rapid cycling. The comparative efficacy of various
antidepressants in bipolar disorder is currently being
studied.
Atypical antipsychotic drugs
In some cases, the newer atypical antipsychotic drugs such as
clozapine or olanzapine may help relieve severe or refractory
symptoms of bipolar disorder and prevent recurrences of mania. More
research is needed to establish the safety and efficacy of atypical
antipsychotics as long-term treatments for this disorder.
Psychotherapy
Certain types of psychotherapy or psychosocial interventions, in
combination with medication, often can provide additional benefit.
These include cognitive-behavioral therapy, interpersonal and
social rhythm therapy, family systems therapy, and
psychoeducation.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) was an accepted treatment in the
past, and is still used today when other treatments have failed.
There is current research work on transcranial magnetic stimulation
as an alternative to ECT.