Psychosomatic Medicine

Lithium treatment is the most effective prophylactic treatment for bipolar disorder, protecting against both new episodes of depression and mania, and reducing the risk of suicide. However, the benefits of lithium are restricted by its renal adverse effects, the most serious being the progression of renal insufficiency to end-stage renal failure with need for renal replacement therapy.

The overall aim of our studies is to increase patient safety during long-term prophylactic lithium treatment.

 Previous studies indicate that the development of renal insufficiency cannot be explained by lithium exposure alone but that additional factors are operative. The pathogenesis of lithium-associated renal impairment is still poorly understood but our hypothesis is that among those factors are co-morbid somatic diseases. Identification of these conditions will lead to a more individualized treatment of the bipolar patient and subsequently reduce the risk for nephropathy.

Data from laboratory registers, registers for diagnosis, drug treatment, and the Swedish Renal Registry will be used together with reviews of medical records as appropriate.

Results can be expected to improve treatment recommendations and safety routines as well as our knowledge of when to stop treatment before the progression of renal impairment becomes irreversible.