ABSTRACT
Lithium, a natural salt, was discovered in 1817. It has been used to treat various medical conditions for the past 175 years. Initially, lithia salts were used to treat gout, which was believed to include symptoms of depression and mania. After serious toxicity was associated with its widespread use in elixirs and tonics and as a salt substitute, it fell out of favor (Lenox and Manji, 1995; Manji et al., 1999, 2000; Lenox and Hahn, 2000). Lithium was then rediscovered in the 1950s by Cade (1949) for the treatment of both acute bipolar mania and depression, as well as for long-term bipolar disorder prophylaxis (Hirschfeld, 1994; Bowden, 1998). There have been more studies of lithium in the treatment of bipolar children and adolescents than any other mood stabilizer, but the majority of these studies are uncontrolled and in heterogeneous groups of patients. Lithium’s only FDA-established indication is for the acute and maintenance treatment of bipolar disorders in patients at least 12 years old. Nonetheless, lithium’s usefulness in treating a wide variety of psychiatric disorders in both adolescents and children younger than 12 years of age continues to be actively investigated. The majority of these studies explore lithium’s utility in the treatment of child and adolescent
416 DelBello and Kowatch
TABLE 1 Pharmacokinetic Properties of Lithium
Principle route Absorption Peak serum levels Serum half-life of excretion
Gastrointestinal 2-4 hours 20-24 hours Renal
bipolar disorder, augmenting antidepressants in the treatment of depression, and the treatment of aggressive behaviors, including disruptive behavioral and attention-deficit hyperactivity disorders (Youngerman and Canino, 1978; Jefferson, 1982; Fetner and Geller, 1992; Kafantaris, 1995; Geller and Luby, 1997; Kowatch and Bucci, 1998; Ryan et al., 1999).
