LITHIUM IN THE TREATMENT OF BIPOLAR DISORDER--MONITORING OF THE ADVERSE EFFECTS/LITIJUM U LECENJU BIPOLARNOG POREMECAJA--PRACENJE NEELJENIH DEJSTAVA

Introduction. Lithium therapy remains the gold standard in the treatment of bipolar disorder and clinical guidelines recommend it as the first choice for maintenance treatment of bipolar disorder. However, the use of lithium has decreased over the years, mainly due to the fear of its adverse effects. The aim of this paper was to review current literature data for the monitoring and overcoming side effects of lithium therapy in order to provide contemporary evidence for adequate lithium use. Material and Methods. A literature review of lithium therapy in bipolar disorder, using both Medline and manual searches, was performed. Classification of studies, in relation to their quality, was performed using the guidelines established by the American Academy of Neurology. Results. Despite methodological limitations of recent studies, there is irrefutable evidence that lithium therapy can cause toxicity and side effects related to renal, thyroid and parathyroid function, as well as weight gain. Conclusion. There is clear evidence that lithium can cause various side effects, but clinically significant conditions in this regard are rare and successfully treated. Literature data confirm strong efficacy of lithium and suggest its wider use in bipolar disorder. By following clinical recommendations and careful monitoring during lithium treatment, the risk of serious side effects is low compared to its efficacy. Key words: Bipolar Disorder; Lithium; Antimanic Agents; Drug-Related Side Effects and Adverse Reactions; Risk Assessment; Kidney Function Tests; Thyroid Function Tests; Teratogens; Weight Gain; Parathyroid Glands Uvod. Terapija litijumom predstavlja zlatni standard u lecenju bipolarnog poremecaja i klinicki vodici je preporucuju kao prvi izbor u tretmanu održavanja. Svedoci smo smanjene upotrebe litijuma tokom proteklih godina uglavnom zbog straha od neželjenih efekata. Cilj istraživanja je bio razmatranje aktuelnih podataka iz literature koji se odnose na monitoring i prevazilaženje neželjenih efekata nastalih zbog tretmana litijumom sa ciljem pružanja savremenih dokaza za adekvatnu primenu ovog leka. Materijal i metode. Korišcenjem indeksne baze Medline pregledana je literatura koja se odnosi na terapiju bipolarnog poremecaja litijumom. Rezultati. Uprkos metodološkim ogranicenjima savremenih istraživanja, pronadeni su neoborivi dokazi da terapija litijumom može da izazove toksicnost i neželjene efekte koji se odnose na bubrežnu, tiroidnu i paratiroidnu funkciju