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A Selective Association between Central and Peripheral Lithium Levels in Remitters in Bipolar Depression: A 3T-(7) Li
R Machado-Vieira1,2,3, M C Otaduy2,4, M V Zanetti1,2
1Laboratory of Neuroscience, LIM- 27, Institute and Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.
Acta Psychiatrica Scandinavica
|October 30, 2015
Summary
Lithium levels in the brain and plasma correlate in bipolar depression remitters, but not non-remitters. Non-remitters may have impaired lithium transport to the brain, suggesting a mechanism for treatment resistance.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Bipolar depression treatment often involves lithium.
- Measuring brain lithium levels non-invasively is crucial for understanding treatment efficacy.
- Individual variability in lithium response suggests pharmacokinetic differences.
Purpose of the Study:
- To assess brain lithium concentrations using (7) Li magnetic resonance spectroscopy after 6 weeks of lithium therapy.
- To investigate the correlation between brain and plasma lithium levels.
- To compare lithium pharmacokinetics and brain/plasma ratios in responders versus non-responders.
Main Methods:
- Twenty-three patients with bipolar disorder (I and II) in depressive episodes participated.
- A flexible lithium dosage (450-900 mg/day) was administered for 6 weeks.
- (7) Li-MRS scans were performed at endpoint to quantify brain lithium concentrations.
Main Results:
- A significant correlation between brain and plasma lithium was observed only in remitters (r = 0.7, P = 0.004).
- Brain lithium levels showed an inverse correlation with age (r = -0.46, P = 0.025), unlike plasma levels.
- Plasma lithium levels did not correlate with clinical outcomes, dosage, or adverse effects.
Conclusions:
- Non-remitters may exhibit impaired lithium transport into the brain, potentially explaining lithium resistance in bipolar disorder.
- Further research integrating (7) Li-MRS with blood-brain barrier transport mechanisms is needed.
- Longitudinal studies are warranted to explore lithium's role in aging and bipolar disorder.
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