Lithium treatment in children and adolescents with anorexia nervosa: clinical use, side effects and tolerability

Purpose. Current guidelines, due to potential toxicity and lack of clinical evidence, do not recommend the use of lithium in the treatment of Anorexia Nervosa (AN). Scarce evidence is available on the use, side effects, and tolerability of this drug in children and adolescents with AN, a population characterized by specific clinical, metabolic, and hydro-electrolytic balance features. Here we report a case series of children and adolescents hospitalized for AN and treated with lithium. Methods. Case series reporting the use of lithium in 7 female young patients with AN. Reasons for introduction, dosages, formulation, plasma levels, adverse drug reactions (ADR) and modifications of electrocardiogram (EKG) and plasma levels of glucose, cholesterol, creatinine, urea, sodium, and thyroid-stimulating hormone (TSH) were assessed. Results. Reasons for the introduction of lithium included unstable mood, insufficient compliance with nutritional programs, and psychomotor agitation. In all of the patients an improvement on target symptoms was observed. Lithium was started at 171.4 (+/-56.7) mg/day, up to 600.0 (+/- 173.2) mg/day. The most frequent scheme was three times daily. The mean plasmatic concentration was 0.6 (+/-0.3) mmol/L at one month. One patient experienced polyuria, polydipsia and dry mouth, and another showed increased creatinine kinase. No major modifications of EKG, glucose, cholesterol, creatinine, urea, sodium emerged. Conclusions. In this sample of children and adolescents hospitalized for AN, lithium was administered to improve psychiatric symptoms impairing compliance. All the patients experienced an improvement on these symptoms after being administered lithium. ADR were reported in 2 cases. These data should be investigated in wider populations and controlled studies.