ABSTRACT
This chapter reviews the history and general pharmacology of the Lithium (Li+) ion. Making the correct diagnosis in situations where clinical presentations and syndromes can be identical is crucial to effectively treating patients with lithium. Treatment of acute Li+ poisoning is based on standard principles of managing toxic ingestions: accurate diagnosis, vital support, limiting absorption, and promoting excretion. Thyrotropin Releasing Hormone (TRH) testing has been applied to the question of distinguishing unipolar depression from bipolar depression which might be Li+-responsive. The central monoaminergic systems are also hypothesized to impact on the Hypothalmic-pituitary-thyroid neuroendocrine system via norepinephrine/dopamine stimulation of TRH release from the hypothalamus and serotonin inhibition of such release. The dexamethasone suppression test is another neuroendocrine test which is especially helpful in confirming the diagnosis of a primary affective disorder. The diurnal cortisol test involves measuring the day-night variation in serum cortisol level over a 24-hr period.
