I recently got a call from an aging family member who has suffered with bipolar disorder, untreated for most of his life. He explained to me about the police cars that had “surrounded” his home and were “monitoring” him, but really were trying to harm him because they were involved in a “conspiracy with the gangsters who live down the street.”

I sighed. This was just another in a long line of these kinds of episodes, and I was pretty sure it would resolve on its own with my relative hunkering down in his house for a while until he was sure the police had gone away.

But then I decided to go see him as soon as I could, because he just turned 80 and I began to wonder if I should be worried that in addition to his bipolar disorder he might not be showing some signs of dementia. I wasn’t sure about the overlap between bipolar and dementia. We know from studies that people with bipolar disorder often have cognitive problems – memory, executive function, and other thinking problems. But does this put them at higher risk for memory problems in old age?

A study published last week entitled “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis” (Cipriani et al The Lancet 17 Aug 2011) reviewed many previous trials of medications for mania. It looked at results for any of the following medications: Aripiprazole (Abilify) , asenapine (Saphris), carbamazepine (Tegretol) , valproate (Depakote) , gabapentin (Neurontin), haloperidol (Haldol), Lamotrigine (Lamictal), lithium, Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) , topiramate (Topamax), and Ziprasidone (Geodon).

Kim Asks…

Is there a way to combat the headaches and joint pains when taking the lithium?

Dr. Fink Answers…

Hi, Kim. Good question. Most importantly discuss these side effects with your doctor immediately. Your doctor may want to run a blood test to determine your lithium level and make sure your lithium level is not toxic. Headaches can indicate toxicity. Headaches may also be a sign of dehydration, which can occur with lithium, so keeping hydrated is important.

In an article published in this month’s Biological Psychiatry entitled “Structural Magnetic Resonance Imaging in Bipolar Disorder: An International Collaborative Mega-Analysis of Individual Adult Patient Data” (Hallahan et al.), researchers pulled together a large number of magnetic resonance imaging studies to compare the brains of people with bipolar disorder to those of healthy control subjects. Their goal was to make sense of some of the conflicting data that had come out of the studies individually.

Using so many studies, from research groups all over the world, the authors are able to examine all of the results together and come up with some more comprehensive findings. This is called a “meta- analysis.” “Mega-analysis” is an informal term that describes a huge meta-analysis.

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Romy103 Asks…

My 21-year old daughter is diagnosed with Bipolar II. After being on Welbutrin and Lamictal, for awhile and doing well, she thought she was okay and decided to stop her medications. She relapsed, and the meds didn’t work as well when she went back on them. So Prozac and Lamictal were tried I believe, then Cymbalta – neither seemed to help. Now a new psychiatrist is prescribing the extended release form of lithium. So far not getting any results, but not up to therapeutic dose yet. While I understand the good things about lithium, I have a few concerns/questions about it:

Sandra C. Asks…

I have been diagnosed with Bipolar Disorder for 3 years. I spent one month and many drugs on a psych unit at the hospital where I was an RN on staff. After approximately one year, I got rid of oh so many drugs down to Lithium Carbonate and Ambien for sleep.

Many people who carry the bipolar diagnosis also carry something else – extra pounds – primarily due to the medications used to treat mania or depression. Atypical antipsychotics, including Zyprexa and Seroquel; anti-manics, including lithium and Depakote; and even some antidepressants have been known to pack on the pounds, despite a person’s best efforts to stay fit and trim.

A number of people have written about their experiences with lithium orotate as an alternative to pharmaceutical lithium (lithium carbonate or lithium citrate). I wanted to know more about it, so I reviewed the research. The bottom line is that we know very little about lithium orotate – the data is scant and old and tells us very little about the safety or effectiveness of lithium orotate as a substitute for lithium carbonate, the standard formulation.

People are often frightened when the doctor raises the possibility of lithium treatment – it conjures up all kinds of images from the media and Hollywood of dark, dangerous institutions and wild kinds of symptoms. Patients often look surprised when I mention it – saying, “but isn’t that for only really crazy people?” It is unfortunate that lithium has gotten such a bad rap, because it is one of our best tested, longest used (since the 1960s), and most effective interventions for bipolar disorder. Here’s a list of its many benefits: