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Decreasing lithium dosage reduces morbidity and side-effects during prophylaxis.

A Coppen, M Abou-Saleh, P Milln

    Journal of Affective Disorders
    |November 1, 1983
    PubMed
    Summary

    Reducing lithium dosage significantly decreased affective morbidity and side effects in patients. A lower plasma lithium level (0.45-0.79 mmol/l) proved more effective and safer than conventional dosages.

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    Area of Science:

    • Psychiatry
    • Pharmacology

    Background:

    • Lithium is a common mood stabilizer for bipolar disorder.
    • Optimizing lithium dosage is crucial for balancing efficacy and tolerability.

    Purpose of the Study:

    • To investigate the impact of reduced lithium dosage on affective morbidity and side effects.
    • To compare the efficacy and safety of reduced lithium levels with standard dosages.

    Main Methods:

    • Prospective, double-blind, randomized trial with 72 patients.
    • Patients were allocated to continue usual lithium dose, or a 25% or 50% reduction.
    • Plasma lithium levels, affective morbidity, thyroid stimulating hormone (TSH), and side effects were monitored.

    Main Results:

    • Reduced lithium dosage (0.45-0.79 mmol/l) significantly decreased affective morbidity and TSH levels.

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  • Subjective side effects and tremor were also reduced in the dose-reduction group.
  • No changes in affective morbidity were observed in the group maintaining their usual lithium dose.

    • Conclusions:

    • A once-daily, sustained-release lithium preparation maintaining a 12-h plasma level of approximately 0.6 mmol/l is more effective.
    • Lower lithium dosages offer improved efficacy and reduced side effects compared to conventional dosing.
    • This approach benefits both unipolar and bipolar patients.