A patient recently asked me, “Why are you starting me on lithium? Isn't that what's in batteries? If I'm supposed to be getting my mood stabilized, isn't this going to make me like the Energizer® Bunny…?” I really couldn't blame him for asking such questions. Why are we using battery contents to flatten out mood episodes? Why is a deadly former salt-substitute now doled out in prescription bottles? With its many and varied uses medicinally and non-medicinally as well as the urban legends surrounding lithium and its side effects, it's no wonder there is a bit of mystery and maybe
LITHIUM SERUM CONCENTRATIONS AND ADVERSE EFFECT MONITORING
In general, the “more stable” the patient is, the less frequent the monitoring required. As concerns about drug interactions, adverse effects, compliance, etc. increase, more frequent monitoring may be necessary.
CLINICAL EFFICACY
Other rating scales are also available, including those specifically for children (with some being completed by parents). Mood charting programs are also available for outpatients to complete on a daily or weekly basis. The results are subsequently reported to the clinician treating the patient. Rating scales can be performed as frequently as deemed clinically necessary, with outpatients generally requiring less frequent
Available options are limited for patients with neutropenia needing to be initiated or maintained on clozapine therapy. A common strategy that is often utilized in these patients is the use of lithium as augmentation to clozapine, which enables the health care provider a means of continuing or initiating clozapine therapy. This article reviews the mechanism and literature evidence behind this treatment strategy.
Bipolar illness can be particularly difficult to manage in pregnancy and during the post-partum period. The risks of mood stabilizing medication on the health of the infant must be considered carefully along with the risks of uncontrolled illness in the mother. Lithium use in pregnancy and lactation has been associated with a number of negative effects in the newborn. This article reviews the latest evidence regarding the risks and benefits of the use of lithium in pregnant or lactating women.
Lithium has been used for more than 50 years for the treatment of bipolar disorder. There is a substantial body of literature about use of lithium in this condition, much of it with conflicting results. Many guidelines and algorithms support the use of lithium for treatment of episodes of acute mania and depression. However, additional research exploring prevention of depressive and manic relapse, treatment of acute depression, and use of combination treatments are needed.
Although lithium does not have an FDA approved indication for augmentation of an antidepressant in major depressive disorder, it has been prescribed for this purpose for decades. While a wide variety of medications have been used historically in this capacity, lithium is one of the few agents that has demonstrated efficacy in multiple randomized controlled trials. Although the ideal role for lithium augmentation has yet to be established, there is currently ample evidence to support the clinical practice of adding lithium to conventional antidepressants in pursuit of major depressive disorder remission.
The transition to this new fiscal and membership year for CPNP finds our organization with a “lot of plates in the air.” Once again, a successful Annual Meeting seems to have infused a great deal of energy, enthusiasm and momentum into our membership and into our committees.
As Jerry McKee mentioned in his June letter and in the article in this edition of MHC, a flurry of activity has developed surrounding the definition/identification of next steps for CPNP to pursue to obtain a mechanism for payment for pharmacist services. That flurry continues, and it may become a blizzard. CPNP has
A reminder that a special subscription price is available to Current Psychiatry, a monthly peer-reviewed publication, and the leading source of practical, evidence-based information for healthcare professionals treating psychiatric patients. Thanks to the CPNP partnership with Current Psychiatry, CPNP members can receive a year of Current Psychiatry at a cost of $24, over 77% less than the normal subscription rate.
Those of you on-site at the CPNP Annual Meeting in Tampa will recall numerous discussions regarding CPNP's efforts in the legislative arena. In an effort to ensure that all organizational efforts in the realm of clinical recognition and reimbursement are well coordinated and synergistic, CPNP leadership has formed an oversight group that reports to the Board of Directors. The Comprehensive Medication Management Reimbursement (CMMR) Task Force has been formed to coordinate and oversee the various CPNP committees that are working towards our goals of gaining recognition of psychiatric pharmacists as essential care team members and in gaining reimbursement