For adolescents grappling with emotional dysregulation across mood swings, impulsivity, and unstable behavior, treatment options can be inconsistent and often limited. But in a recent study, one long-standing psychiatric agent showed promise: lithium.
Adjunctive lithium therapy was associated with significantly reduced symptom severity at 6 months in adolescents with severe emotional dysregulation, based on a retrospective analysis of 35 inpatients aged 13 to 17 years. However, the difference between treatment groups was not statistically significant at 12 months, and the lithium group had more complex clinical profiles at baseline, limiting generalizability.
Participants were divided into 2 groups: 17 patients received lithium as an add-on therapy (lithium group), and 18 received standard pharmacologic treatment alone (control group). All patients had clinically significant emotional dysregulation, defined by elevated scores on at least three subscales of the Difficulties in Emotion Regulation Scale.
Symptom severity was assessed using the Clinical Global Impression–Severity (CGI-S) scale, and global functioning was measured via the Children’s Global Assessment Scale.
At 6 months, the lithium group showed a significantly greater reduction in CGI-S scores compared with the control group (F(1,33) = 5.233; P = .029). CGI-S scores declined significantly in the lithium group (P < .001), while no significant change was observed in the control group (P = .381). By 12 months, symptom severity remained reduced in both groups, though no statistically significant difference was observed between them.
Both groups showed significant improvement in global functioning over time (P < .001), with no significant group-by-time interaction, indicating similar rates of improvement.
Dr. Federica Gigliotti, of the Department of Human Neuroscience, Sapienza University of Rome, and colleagues, stated, “In terms of primary clinical outcomes, both groups experienced a reduction in symptom severity at 6 months, with the lithium group exhibiting greater improvement. At 12 months, symptom severity remained reduced in both groups, and the differences between them were no longer significant.”
At baseline, the lithium group had more complex clinical profiles. All had received prior pharmacologic treatment (100% vs 22.2% in controls; P < .001) and had a greater number of psychiatric hospitalizations (mean 2.53 vs 0.67; P < .001). They were also prescribed more psychotropic medications on average (mean 2.11 vs 1.22; P < .001).
Serum lithium levels averaged 0.75 mEq/L (standard deviation [SD] = 0.17) at 6 months and 0.72 mEq/L (SD = 0.17) at 12 months, within the lower therapeutic range.
Adverse effects were more common in the lithium group but did not affect adherence. At 6 months, adverse effects in the lithium group ranged from none to multiple, with more than half reporting at least one effect. The most frequent effects were metabolic (38%, including weight gain), neurological (27%, primarily sedation), and endocrine (22%, mostly thyroid dysfunction). Despite these findings, 47% of lithium patients and 50% of control patients were rated as having good adherence (P = .597). No patients discontinued lithium due to adverse events.
The authors acknowledged limitations, including small sample size and lack of randomization. However, they concluded that lithium may be a beneficial adjunctive treatment for adolescents with severe emotional dysregulation who do not respond adequately to standard care.
The authors reported no conflicts of interest.
Source: Journal of Clinical Medicine
