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Re: wait a second? » clint878

Posted by Squiggles on November 5, 2006, at 17:16:23

In reply to Re: wait a second?, posted by clint878 on November 5, 2006, at 16:25:48

> Take a look at:
>, which details the cognitive function of bipolar patients. One part mentions that patients on no medications also have difficulty.

Before I ever was diagnosed as bipolar, I was
enrolled in Psychology -- i almost finished the degree, but then switched to Philosophy for the M.A. Even then, i never trusted the cognitive tests, reminding me too much as the offspring of the Rocharch tests and the highschool tests.
As for the neuroanatomical changes in the brain (especially after years of lithium), there is the contrary school of thought on how lithium actually acts as a neurogenerative agent:

1.Neuropharmacology 43 (2002) 1173­1179
Lithium induces brain-derived neurotrophic factor and activates
TrkB in rodent cortical neurons: An essential step for
neuroprotection against glutamate excitotoxicity
Ryota Hashimoto a, Nobuyuki Takei b, Kazuhiro Shimazu c, Lori Christ a, Bai Lu c,
De-Maw Chuang a,
a Molecular Neurobiology Section, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health,
Bethesda, MD, 20892-1363, USA
b Department of Molecular Neurobiology, Brain Research Institute, Niigata University, Niigata, Niigata, 951-8585, Japan
c Unit on Synapse Development & Plasticity, National Institutes of Child Health and Human Development, National Institutes of Health,
Bethesda, MD, 20892-4480, USA
Received 26 February 2002; received in revised form 18 July 2002; accepted 6 August 2002
Mechanisms underlying the therapeutic effects of lithium for bipolar mood disorder remain poorly understood. Recent studies
demonstrate that lithium has neuroprotective actions against a variety of insults in vitro and in vivo. This study was undertaken to
investigate the role of the brain-derived neurotrophic factor (BDNF)/TrkB signaling pathway in mediating neuroprotection of lithium
against glutamate excitotoxicity in cortical neurons. Pretreatment with either lithium or BDNF protected rat cerebral cortical neurons
from glutamate excitotoxicity. The duration of treatment required to elicit maximal neuroprotection by BDNF (1 day) was much
shorter than that by lithium (6 days). K252a, an inhibitor of Trk tyrosine kinases, and a BDNF neutralizing antibody suppressed
the neuroprotective effect of lithium. Treatment of cortical neurons with lithium increased the cellular BDNF content in 3 days
and the phosphorylation of TrkB at Tyr490 in 5 days, suggesting that long-term lithium administration enhances BDNF
expression/secretion, leading to the activation of TrkB receptor. Lithium failed to protect against glutamate excitotoxicity in cortical
neurons derived from homozygous and heterozygous BDNF knockout mice, although lithium fully protected cortical neurons pre-
pared from wild type mice littermates. Taken together, these data suggest that the BDNF/TrkB pathway plays an essential role in
mediating the neuroprotective effect of lithium.
Published by Elsevier Science Ltd.
Keywords: Lithium; BDNF; TrkB; Excitotoxicity; Neuroprotection; Cerebral cortical neuron


"Lithium: How Good is it?

Many people worry that lithium is one of psychiatry's "Big Guns", something we use for patients with really severe mental illnesses. They think, "Hey, I'm not that sick", and conclude that lithium is not right for them.

They don't know that lithium, in lower doses, is used in plain depression (not bipolar, not severe). In fact, for depression that hasn't fully responded to an antidepressant, one research group calls it "Step 1A" -- the thing to do, in some cases, before switching to another antidepressant.

But one of the strongest arguments for lithium is the way it appears to protect neurons. So I wanted to show you the world's expert on how lithium works, talking about this aspect of lithium's potential benefits. His full comments, on a range of topics, from his interview with a great bipolar advocacy organization, can be read on this link at the Child and Adolescent Bipolar Foundation (CABF).

Here are Dr. Manji's comments about lithium (it's a little technical; look for the few ideas I put in bold if you're getting bogged down):

CABF: Speaking of lithium, your research has uncovered some of its intriguing beneficial properties. Can you highlight the most important ones?

MANJI: Many of the genes that are considered neuroprotective [keep brain cells from dying when stressed] are being remarkably turned on by lithium. Is lithium actually neuroprotective? We hadn't thought this way before. A number of studies have taken animal cells and tried to kill them by causing stroke, etc. These studies have consistently shown that lithium, if administered before you try to do the bad things (such as induce a stroke), protects the animal's neurons. In lithium-treated brains, the size of the resulting stroke is smaller, the number of neurons that die is lower, etc. That was amazing. Since these studies were done in rats, you need to be careful about jumping to conclusions that lithium is neuroprotective in people.

Wayne Drevets' group published a finding in Nature about five years ago that in a part of the pre-frontal cortex of bipolar patients or patients with familial recurring unipolar depression, there was almost a 40% reduction in the amount of gray matter. That was a remarkable finding that you have such a reduction in a discrete part of brain. We spoke to him about our lithium findings and asked him to reanalyze the data. He had a small group of patients who had been treated with lithium for a long time and they did not show the brain atrophy compared with the bipolar patients. Interestingly all of the patients with unipolar depression, whether or not they had been treated with antidepressants, still showed the atrophy. That was a suggestion that bipolar treatments might have a protective effect.

Valproate (Depakote) in the prefrontal cortex seemed to have the same type of neuroprotective properties. Lithium and depakote do not have identical effects in every brain area, but in this area they did. Brains treated with chronic lithium or valproate seemed not to have the atrophy in the prefrontal cortex. But it was a very small sample and a crossectional study [type of study whose design restricts its findings to association between variables, not proof of cause]. He studied them once. We don't know if it was a cause or effect. Is it the people who don't have the atrophy who responded to the drug in the first place?

We did some studies taking bipolar patients off their meds -- they were referred to us because their treatments weren't working. In every case, they either hadn't been on lithium or had been on lithium sparingly -- had started on it, had side effects, switched, and the new med was not working. These are bipolar depressed patients. We did MRI scans and MRS spectroscopy and then put them on lithium in a blinded fashion for 4-6 weeks. Then we did the scans again. We found that almost every single person taking lithium had an increase in N-acetylaspartic acid (NAA) [an amino acid that is viewed as a marker of neuronal health]. And the actual amount of gray matter was going up when they were treated chronically with lithium. This study was done together with Dr. Greg Mooreč. This was happening in areas of the patients' brains that had been atrophied. The increase was not due to swelling from water retention. The increase was seen only in areas where the brain matter had previously atrophied.

Our working hypothesis, and I think it is reasonable, is that lithium is turning on some of these growth signaling pathways and reversing the damage. It seems that the cells are shrunken, not dead, and are capable of going back to their normal sizes and sending normal projections. What lithium seems to be doing is turning on the signaling pathways that produce growth factors in the brain, such as brain-derived neurotrophic factor (BDNF), and where you have atrophy, turning on this pathway seems to be capable of reversing it. And that is a remarkable finding.

A couple of other studies since then have compared lithium-treated patients with untreated patients. They showed that the lithium-treated patients have the increase in gray matter, suggesting that lithium is causing the increase. If that is the case, lithium has a neurotrophic [nourishing to neurons] effect. Would lithium, then, be beneficial in any bipolar patient, even if he or she can't tolerate it or if his or her symptoms respond better to another mood stabilizer? One question is tolerability. We've done a number of animal studies with low-dose lithium. We found that in animals, with a dose of lithium that is one-half or one-third of a usual dose, you still get a large increase in bcl-2, a neuroprotective protein. This suggests that it is quite possible that even low-dose lithium will exert these effects. Many studies are being planned using low-dose lithium as an additional agent in patients being treated with something else. We will add low-dose lithium and follow them for 2-3 years with repeated MRIs and neuropsych testing to see if the addition would be enough to provide neuroprotective effects that would help them long-term with the illness, even if something else is their appropriate treatment for symptoms. That is extremely important. It is a devastating long-term illness, and brain atrophy may be responsible for that. If we can intervene early on and prevent that, there is reason to believe you will have a big impact on the overall course of the illness."





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