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      Lithium: What can we do to overcome the discrepancies between evidence, guideline recommendations and clinical practice?

      European Neuropsychopharmacology
      Elsevier BV

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          20-Year Trends in the Pharmacologic Treatment of Bipolar Disorder by Psychiatrists in Outpatient Care Settings

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            Is Open Access

            Clinical use of lithium salts: guide for users and prescribers

            Background Lithium has been used clinically for 70 years, mainly to treat bipolar disorder. Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries, encouraging this update about its safe clinical use. We conducted a nonsystematic review of recent research reports and developed consensus among international experts on the use of lithium to treat major mood disorders, aiming for a simple but authoritative guide for patients and prescribers. Main text We summarized recommendations concerning safe clinical use of lithium salts to treat major mood disorders, including indications, dosing, clinical monitoring, adverse effects and use in specific circumstances including during pregnancy and for the elderly. Conclusions Lithium continues as the standard and most extensively evaluated treatment for bipolar disorder, especially for long-term prophylaxis.
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              Lithium’s antiviral effects: a potential drug for CoViD-19 disease?

              Background Since its introduction in modern medicine, naturalistic observations emerged about possible uses of lithium treatment for conditions different from recurring affective disorders, for which it is still a first-line treatment option. Some evidence about the antiviral properties of lithium began in the early 1970s, when some reports found a reduction of labial-herpetic recurrences. The present review aims to present most of the pre-clinical and clinical evidence about lithium’s ability to inhibit DNA and RNA viruses, including Coronaviridae, as well as the possible pathways and mechanisms involved in such antiviral activity. Main body Despite a broad number of in vitro studies, the rationale for the antiviral activity of lithium failed to translate into methodologically sound clinical studies demonstrating its antiviral efficacy. In addition, the tolerability of lithium as an antiviral agent should be addressed. In fact, treatment with lithium requires continuous monitoring of its serum levels in order to prevent acute toxicity and long-term side effects, most notably affecting the kidney and thyroid. Yet lithium reaches heterogeneous but bioequivalent concentrations in different tissues, and the anatomical compartment of the viral infection might underpin a different, lower need for tolerability concerns which need to be addressed. Conclusions Lithium presents a clear antiviral activity demonstrated at preclinical level, but that remains to be confirmed in clinical settings. In addition, the pleiotropic mechanisms of action of lithium may provide an insight for its possible use as antiviral agent targeting specific pathways.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                European Neuropsychopharmacology
                European Neuropsychopharmacology
                Elsevier BV
                0924977X
                July 2022
                July 2022
                : 60
                : 1-3
                Article
                10.1016/j.euroneuro.2022.03.007
                35397384
                0fc8a285-60b1-40ca-afa4-f4a54e41f4f6
                © 2022

                https://www.elsevier.com/tdm/userlicense/1.0/

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