Abstract THE mechanism of action of the lithium ion in man remains obscure although it is being increasingly used especially in the treatment of manic-depressive disorder. In the similarity to sodium in the periodic table, its ability to substitute for sodium in medium surrounding nerves1 and muscles2 in some in vitro systems and its active transport in biological systems3,4 have raised the possibility that a mechanism related, at least in part, to sodium metabolism may explain its actions. Coppen et al initially described several striking changes in electrolyte and water distribution in schizophrenic patients studied before and one week after receiving 1 gm of lithium carbonate daily.5 These changes included an increase in total body water and extracellular fluid (ECF) volume, and a fall in 24-hour exchangeable sodium (Nae), sodium space and residual sodium (Nar). More recently, he was unable to confirm References 1. Hodgkin, A.L., and Katz, B.: The Effect of Sodium Ions on the Electrical Activity of the Giant Axon of the Squid , J Physiol 108:37-77 ( (March) ) 1949. 2. Keynes, R.D., and Swan, R.C.: The Permeability of Frog Muscle Fibers to Lithium Ions , J Physiol 147:626-638 ( (Oct) ) 1959. 3. Zerahn, K.: Studies on the Active Transport of Lithium in the Isolated Frog Skin , Acta Physiol 33:347-358 ( (Aug) ) 1955.Crossref 4. Sexton, A.W., and Meyer, D.K.: Effects of Potassium, Cesium, and Lithium Ions on Sodium Transport Through Gills of Goldfish , Fed Proc 14:137 ( (March) ) 1955. 5. Coppen, A.; Malleson, A.; and Shaw, D.M.: Effects of Lithium Carbonate on Electrolyte Distribution in Man , Lancet 1:682-683 ( (March) ) 1965.Crossref 6. Coppen, A., and Shaw, D.M.: The Distribution of Electrolytes and Water in Patients After Taking Lithium Carbonate , Lancet 2:805-806 ( (Oct) ) 1967.Crossref 7. Kellam, S.G.; Durell, J.; and Shader, R.I.: Nursing Staff Attitudes and the Clinical Course of Psychotic Patients , Arch Gen Psychiat 14:190-202 ( (Feb) ) 1966.Crossref 8. Bunney, W.E., Jr., and Hamburg, D.A.: Methods for Reliable Longitudinal Observations of Behavior , Arch Gen Psychiat 9:280-294 ( (Sept) ) 1963.Crossref 9. Moore, F.D., et al: Body Composition , Metabolism 5:447-467 ( (July) ) 1956. 10. Howe, c.t., and EKINS, R.P.: The Bromide Space After the Intravenous Administration of 82Br , J Nucl Med 4:469-479 ( (Nov) ) 1963. 11. Schou, M.: Biology and Pharmacology of the Lithium Ion , Pharmacol Rev 9:17-58 ( (March) ) 1957. 12. Kaltreider, N.L., et al: Determination of the Volume of the Extracellular Fluid of the Body With Radioactive Sodium , J Exper Med 74:569-590 ( (Dec) ) 1941.Crossref 13. Berson, S.A., and Yalow, R.S.: Critique of Extracellular Space Measurement With Small Ions Na24, Br82 Spaces , Science 121:34-36 ( (Jan) ) 1955.Crossref 14. Gamble, J.L., Jr., and Robertson, J.S.: Volume of Distribution of Radioactive Chloride in Dogs: Comparison With Sodium, Bromide, and Inulin Spaces , Amer J Physiol 171:659-667 ( (Dec) ) 1952. 15. Gibbons, J.L.: Total Body Sodium and Potassium in Depressive Illness , Clin Sci 19:133-138 ( (Feb) ) 1960. 16. Baer, L., et al: Sodium-22 Retention and 17-Hydroxycorticosteroid Excretion in Affective Disorders: A Preliminary Report , J Psychiat Res 6:289-297 ( (May) ) 1969.Crossref 17. Baer, L.; Platman, S.R.; and Fieve, R.R.: Aldosterone Dependent Component of Lithium Metabolism and the Effect of Lithium on Fluid and Electrolyte Balance, presented at the NIMH Workshop on the Psychobiology of Depression, April 1969.
Archives of General Psychiatry – American Medical Association
Published: Jan 1, 1970