In a recent study from Karolinska Institutet, scientists found six predictors that could help determine the amount of lithium needed to treat patients with bipolar disorder.
The study also pinpoints genetic markers that seem to influence how quickly the body eliminates lithium from its system.
Lithium is one of the most important treatments for patients with bipolar disorder, a condition that has been linked to an increased risk of suicide.
The chemical substance works as a mood stabilizer and reduces episodes of depression and mania.
How much is needed varies greatly between individuals and finding the right dose for each patient is key as too much can be toxic while too little is ineffective.
To minimize the risk of side effects, clinicians tend to initiate treatment at low doses that increase over time, meaning it could take months before the treatment has an effect.
To overcome this, researchers have long sought to find a model that could predict the dose response in individual patients.
Previous studies have identified markers such as age, sex, and kidney function as possible predictors of how quickly the body eliminates lithium from its system (lithium clearance).
In the study, the team examined electronic health records and registry data from a total of 2,357 patients with bipolar disorder, which may represent the largest sample size for this kind of study to date.
Both men and women of ages ranging from 17 to 89 were included, mainly of European ancestry.
The team found associations between the speed of lithium clearance and age, sex, kidney function (measured as eGFR), serum lithium concentrations, and medication with diuretics and substances targeting the renin-angiotensin-aldosterone system (RAAS), which could be used to treat hypertension and other conditions.
The findings suggest that older patients, women, patients with reduced kidney function, and those taking certain medications require lower doses of lithium.
Interestingly, we also discovered that the amount of lithium taken and lithium concentrations in the blood do not seem to be completely proportional, which goes somewhat against current thinking.
The study also found associations between a lower lithium clearance and one genetic locus on chromosome 11 and could also show that genetic variants affecting BMI and kidney function were associated with lithium clearance.
Even though adding the genetic markers only marginally improved the model’s predictive capability, the researchers say it opens the opportunity for personalized medicine in lithium treatment in the future.
If you care about mental health, please read studies that commonly used mental drugs may harm cognitive functions, and 6 daily habits to reduce stress & anxiety.
For more information about mental health, please see recent studies about treatments and therapies of bipolar disorder, and results showing scientists find a core feature of depression.
The research is published in The Lancet Psychiatry and was conducted by Martin Schalling et al.
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