Putative Mechanisms of Action and Clinical Use of Lithium in Children and Adolescents: A Critical Review.
Adolescent
Age Factors
Antidepressive Agents
/ administration & dosage
Antimanic Agents
/ administration & dosage
Bipolar Disorder
/ drug therapy
Child
Clinical Trials as Topic
Depressive Disorder, Major
/ drug therapy
Humans
Lithium Compounds
/ administration & dosage
Randomized Controlled Trials as Topic
Children
adolescents
efficacy
lithium
mechanism of action
pharmacokinetics
safety.
Journal
Current neuropharmacology
ISSN: 1875-6190
Titre abrégé: Curr Neuropharmacol
Pays: United Arab Emirates
ID NLM: 101157239
Informations de publication
Date de publication:
2019
2019
Historique:
received:
06
09
2017
revised:
09
10
2017
accepted:
28
11
2017
pubmed:
20
12
2017
medline:
15
8
2019
entrez:
20
12
2017
Statut:
ppublish
Résumé
Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications. To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data. Clinical trials in pediatric samples with at least one standardized measure of efficacy/ effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients. Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe. Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.
Sections du résumé
BACKGROUND
BACKGROUND
Lithium is a first-line treatment for bipolar disorder in adults, but its mechanism of action is still far from clear. Furthermore, evidences of its use in pediatric populations are sparse, not only for bipolar disorders, but also for other possible indications.
OBJECTIVES
OBJECTIVE
To provide a synthesis of published data on the possible mechanisms of action of lithium, as well as on its use in pediatric samples, including pharmacokinetics, efficacy, and safety data.
METHODS
METHODS
Clinical trials in pediatric samples with at least one standardized measure of efficacy/ effectiveness were included in this review. We considered: i) randomized and open label trials, ii) combination studies iii) augmentation studies iv) case series including at least 5 patients.
RESULTS
RESULTS
Different and non-alternative mechanisms of action can explain the clinical efficacy of lithium. Clinical studies in pediatric samples suggest that lithium is effective in managing manic symptoms/episodes of bipolar disorder, both in the acute phase and as maintenance strategy. Efficacy on depressive symptoms/phases of bipolar disorder is much less clear, while studies do not support its use in unipolar depression and severe mood dysregulation. Conversely, it may be effective on aggression in the context of conduct disorder. Other possible indications, with limited published evidence, are the acute attacks in Kleine-Levin syndrome, behavioral symptoms of X-fragile syndrome, and the management of clozapine- or chemotherapy- induced neutropenia. Generally, lithium resulted relatively safe.
CONCLUSIONS
CONCLUSIONS
Lithium seems an effective and well-tolerated medication in pediatric bipolar disorder and aggression, while further evidences are needed for other clinical indications.
Identifiants
pubmed: 29256353
pii: CN-EPUB-87462
doi: 10.2174/1570159X16666171219142120
pmc: PMC6482478
doi:
Substances chimiques
Antidepressive Agents
0
Antimanic Agents
0
Lithium Compounds
0
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Pagination
318-341Informations de copyright
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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