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Lithium for ADHD


Lithium for ADHD

1. Areas of application for lithium

  • Acute treatment of mania
  • Prophylaxis of manic-depressive and unipolar affective psychoses

2. Mechanisms of action of lithium

Lithium influences

  • Functionality of nerve cells

  • Ion channels

  • Neurotransmitters, among others:

    • Serotonin
    • Dopamine
    • Noradrenaline
  • “Second messenger systems”, e.g.

    • based on phosphoinositol
    • based on cAMP
  • protects/increases the volume of brain structures involved in emotional regulation, such as

    • PFC
    • Hippocampus
    • Amygdala
  • reduces the excitatory activity

    • Dopamine
    • Glutamate
  • increases inhibitory neurotransmission

    • GABA
  • reduces oxidative stress

  • increases protective proteins

    • Neutrotrophins
    • Bcl-2 increased
  • reduces apoptotic processes by

    • Inhibition of glycogen synthase kinase 3 (GSK-3)
    • Inhibition of autophagocytosis

3. Lithium for ADHD

A randomized, double-blind crossover design study of 32 adults with ADHD compared 8 weeks of MPH (up to 40 mg/day) and 8 weeks of lithium (up to 1,200 mg/day). A good improvement in ADHD symptoms was seen in 48% of those taking MPH and 37% of those taking lithium.1

A study on the response to lithium in bipolar disorder found a correlation between a poorer response and an increased polygenic risk score of ADHD, MDD or (in particular) schizophrenia.2

We are not aware of any further studies. The use of lithium for ADHD cannot be recommended on this basis.

4. Side effects of lithium

Especially at the beginning of lithium treatment:

  • fine tremor
  • Polyuria
  • Polydipsia
  • Nausea

With long-term therapy damage to

  • Kidneys
  • Thyroid gland
  • Parathyroid glands

Lithium is said to promote weight gain.3

  1. Dorrego, Canevaro, Kuzis, Sabe, Starkstein (2002): A randomized, double-blind, crossover study of methylphenidate and lithium in adults with attention-deficit/hyperactivity disorder: preliminary findings. J Neuropsychiatry Clin Neurosci. 2002 Summer;14(3):289-95. doi: 10.1176/jnp.14.3.289. PMID: 12154153. n = 32

  2. Coombes BJ, Millischer V, Batzler A, Larrabee B, Hou L, Papiol S, Heilbronner U, Adli M, Akiyama K, Akula N, Amare AT, Ardau R, Arias B, Aubry JM, Backlund L, Bauer M, Baune BT, Bellivier F, Benabarre A, Bengesser S, Bhattacharjee AK, Cervantes P, Chen HC, Chillotti C, Cichon S, Clark SR, Colom F, Cruceanu C, Czerski PM, Dalkner N, Degenhardt F, Del Zompo M, DePaulo JR, Étain B, Falkai P, Ferensztajn-Rochowiak E, Forstner AJ, Frisen L, Gard S, Garnham JS, Goes FS, Grigoroiu-Serbanescu M, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Jamain S, Jiménez E, Kahn JP, Kassem L, Kato T, Kelsoe JR, Kittel-Schneider S, König B, Kuo PH, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Maj M, Manchia M, Martinsson L, McCarthy MJ, McElroy SL, Mitchell PB, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Nöthen MM, Novák T, O’Donovan C, Osby U, Ozaki N, Pfennig A, Pisanu C, Potash JB, Reif A, Reininghaus E, Rietschel M, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schubert KO, Schweizer BW, Severino G, Shekhtman T, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Squassina A, Stamm T, Stopkova P, Tortorella A, Turecki G, Vieta E, Witt SH, Zandi PP, Fullerton JM, Alda M, Frye MA, Schulze TG, McMahon FJ, Biernacka JM (2022): Association of Attention-Deficit/Hyperactivity Disorder and Depression Polygenic Scores with Lithium Response: A Consortium for Lithium Genetics Study. Complex Psychiatry. 2021 Dec;7(3-4):80-89. doi: 10.1159/000519707. PMID: 36408127; PMCID: PMC8740189. n = 2.510

  3. Sanego: Gewichtszunahme bei Lithium. Abgerufen 15.09.22