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Biological predictors of lithium response in bipolar disorder
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Abstract In order to prescribe lithium appropriately to patients with bipolar disorder, predictors of lithium response are helpful. The present paper reviews the biological predictors of lithium response. As a positive predictor of lithium response, the following have been reported: strong loudness dependence of the auditory‐evoked N1/P2‐response; higher brain lithium concentration; lower inositol monophosphatase (IMPase) mRNA expression; higher serotonin‐induced calcium mobilization; increased N‐acetyl‐aspartate peak and decreased myo‐inositol peak; white matter hyperintensity; decreased intracellular pH; higher frequency of phospholipase C γ‐1 (PLCG1)‐5 repeat and PLCG1‐8 repeat; and C973A polymorphism in the inositol polyphosphate 1‐phosphatase gene. In contrast the following have been reported as a predictor of negative lithium response: epileptiform abnormality of electroencephalography; human leukocyte antigen type A3; decreased phosphocreatine peak area after photic stimulation; and homozygotes for the short variant of the serotonin transporter gene. Most of the possible biological predictors of better lithium response, such as lower IMPase mRNA levels, white matter hyperintensity, lower brain intracellular pH, enhanced calcium response, and PLCG1‐5 repeat had been detected as risk factors for bipolar disorder, suggesting that bipolar disorder responding well to maintenance lithium treatment is a distinct category having a certain neurobiological basis, although these findings need further replication. The search for biological predictors of lithium response is still in its infancy. Most of the laboratory or neuroimaging techniques used in these studies are not easily performed in clinical settings, so the development of an easy and useful laboratory test is needed.
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Lack of EEG abnormalities, higher brain lithium concentration, increased N-acetyl aspartate, lower myo-inositol peaks on magnetic resonance spectroscopy, and several variants in candidate gene studies may predict lithium response, but these studies require confirmation.
“Among biological measures, lack of electroencephalogram (EEG) abnormalities, higher brain lithium concentration, increased N‐acetyl aspartate and lower myo‐inositol peaks on magnetic resonance spectroscopy, as well as several variants in candidate gene studies, may predict response,418 but these studies require confirmation.”
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Kato, T. (2007) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2007.01604.x · Cited by 285
“Previous studies showed association of the S/S genotype of HTTLPR with poor lithium response in bipolar disorder.(155) However, a recent report did not support this association,(156) while another study did.”
ResultSelf-citationImpaired feedback regulation of XBP1 as a genetic risk factor for bipolar disorder
Kakiuchi, C., Iwamoto, K., Ishiwata, M., Bundo, M., Kasahara, T., Kusumi, I., Tsujita, T., Okazaki, Y., Nanko, S., Kunugi, H., et al. (2003) · Nature Genetics · doi:10.1038/ng1235 · Cited by 272
“Mood stabilizers, such as valproate, lithium and carbamazepine, are effective in treating this illness, but the treatment response for these drugs varies among individual”
BackgroundSelf-citationPharmacological approaches in bipolar disorders and the impact on cognition: a critical overview
Dias, V. V., Balanzá‐Martinez, V., Soeiro‐de‐Souza, M. G., Moreno, R. A., Figueira, M. L., Machado‐Vieira, R., & Vieta, E. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2012.01910.x · Cited by 146
“Also, given that lithium has a narrow therapeutic margin and well-known side-effects and that good response rates are observed in only about half of patients, more research on the biological predictors of better lithium response (80) and their impact on cognition are needed.”
BackgroundLi, Q. S., Tian, C., Seabrook, G. R., Drevets, W. C., & Narayan, V. A. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.171 · Cited by 72
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“Therefore, many researchers explored psychopathological and biological markers for good response to lithium treatment (Gelenberg and Pies, 2003; Ikeda and Kato, 2003).”
BackgroundSelf-citationNeuronal cell adhesion genes and antidepressant response in three independent samples
Fabbri, C., Crisafulli, C., Gurwitz, D., Stingl, J., Calati, R., Albani, D., Forloni, G., Calabrò, M., Martines, R., Kasper, S. F., et al. (2015) · The Pharmacogenomics Journal · doi:10.1038/tpj.2015.15 · Cited by 37
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“, 2016; Hou and McMahon, 2016) as well as the effect of genetic markers on treatment response in bipolar patients (Ikeda and Kato, 2003; Rybakowski, 2013).”
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“The action of lithium has been well documented in phosphoryl-transfer enzymes such as kinases and phosphatases (Zhen et al. 2002; Ikeda and Kato 2003), but no effect has been previously shown in other mammalian phosphoryl-transfer enzymes such as nucleases.”
BackgroundPharmacogenomics of Lithium Response in Bipolar Disorder
Vecera, C. M., Fries, G. R., Shahani, L., Soares, J. C., & Machado‐Vieira, R. (2021) · Pharmaceuticals · doi:10.3390/ph14040287 · Cited by 22
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“Additionally, it was found that Li bipolar responders have a higher [Ca]i than patients with normal calcium levels, which indicates a correlation between intracellular Ca levels and lithium response (Ikeda and Kato 2003).”
Genetics of Lithium Response in Bipolar Disorder
Papiol, S., Schulze, T. G., & Alda, M. (2018) · Pharmacopsychiatry · doi:10.1055/a-0590-4992 · Cited by 18
“However, most of the findings still need to be replicated, among them the lack of EEG abnormalities, higher brain lithium concentration, increased N-acetyl aspartate, and lower myo-inositol peaks in MRS, as well as several variants in candidate gene studies (reviewed by Ikeda and Kato) [52].”
BackgroundShahaf, G. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00094 · Cited by 16
Biochemical and psychiatric predictors of Li+ response and toxicity in Li+‐treated bipolar patients
Layden, B. T., Minadeo, N., Suhy, J., Abukhdeir, A. M., Metreger, T., Foley, K. A., Borge, G. F., Crayton, J. W., Bryant, F. B., & de Freitas, D. M. (2004) · Bipolar Disorders · doi:10.1046/j.1399-5618.2003.00093.x · Cited by 12
Physiological Correlates of Bipolar Spectrum Disorders and their Treatment
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“3 Treatment Within the EEG and ERP literature, there has been one review examining correlates of lithium treatment effect (Ikeda and Kato 2003).”
BackgroundPrediction of Treatment Outcome in Bipolar Disorder: When Can We Expect Clinical Relevance?
Scott, K., Khayachi, A., Alda, M., & Nunes, A. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.02.005 · Cited by 9
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Clinical relevance of discoveries in psychopharmacogenetics1
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Li+ in Bipolar Disorder – Possible Mechanisms of Its Pharmacological Mode of Action
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“…pointing to an interaction between intracellular signalling mechanisms mediated by Ca2+ and cAMP (Cooper et al., 1995); bipolar patients with a [Ca2+]i higher than normal respond better to Li+ treatment, indicating a possible correlation between Ca2+ levels and Li+ response (Ikeda & Kato, 2003).”
BackgroundGenetic studies of bipolar disorder in patients selected by their treatment response
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Lityuma Tedavi Yanıtının Klinik, Biyolojik ve Genetik Yordayıcıları
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Inositol monophosphatase (E.C.3.1.3.25)
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Towards precision psychiatry: initial foundations and future directions
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“Replicated clinical predictors of response to lithium treatment have also been found 38 ; biological predictors of lithium response have been widely sought, but more work is needed to ascertain their reliability 39 .”
Metadata
- Authors
- Ikeda, A., & Kato, T.
- Affiliations
- The University of Tokyo (JP)
- RIKEN Center for Brain Science (JP)
- ORCID
- Kato, Tadafumi
- Venue
- Psychiatry and Clinical Neurosciences
- Publisher
- Wiley
- Published
- 2003-05-02
- Volume
- 57
- Issue
- 3
- Pages
- 243-250
- ISSN
- 1323-1316 (ISSN-L)
- 1440-1819
- OpenAlex
- W1988239052
- Cited by
- 35
- References
- 113
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2021: 1 · 2019: 1 · 2018: 5 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatry and Clinical Neurosciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- lithium response, bipolar disorder, biological predictors, inositol monophosphatase, N-acetylaspartate, myo-inositol, white matter hyperintensities, intracellular pH, phospholipase C-gamma1, serotonin transporter, human leukocyte antigen, epileptiform EEG abnormalities, photic stimulation, neuroimaging biomarkers
- MeSH terms
- Bipolar Disorder, Brain, Calcium, Electroencephalography, Evoked Potentials, Auditory, Genetic Markers, Humans, Magnetic Resonance Imaging, Phosphoric Monoester Hydrolases, Predictive Value of Tests, Prognosis, RNA, Messenger, Biomarkers, Lithium Carbonate, Antimanic Agents
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