Roger S. McIntyre, MD, FRCPC

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Abstract: Research has shown that nocturia and major depressive disorder are often correlated. The clinician should take a complete history along with performing a physical examination when patients present with symptoms that may be associated with nocturia. Patients rarely seek medical attention solely for treatment of nocturia, so direct questions along with use of the Frequency Volume Chart (FVC) should be used to assess whether underlying disorders or conditions are present. Clinicians should also be alert to the possible presence of nocturia in patients who suffer from major depressive disorder since nocturia rates for this population is significantly higher. Behavioural modifications alone may be insufficient to improve nocturia where clinically depressive symptoms are also present. Pharmacological treatments may provide improvement when nocturia and major depressive disorder are both present.

Key Words: Nocturia, major depressive disorder, anxiety, lithium, SSRIs, Frequency Volume Chart (FVC), sleep hygiene, desmopressin.

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Research has shown that nocturia and major depressive disorder are often correlated.

It is essential that the clinician take a comprehensive history since patients often report symptoms associated with nocturia rather than nocturia itself.

The Frequency Volume Chart (FVC) is a reliable tool the clinician can use to assess whether underlying disorders or conditions are present, which will help determine treatment.

Given the poor physical and mental health that can result when nocturia and major depressive disorder are both present, the clinician should consider pharmacological treatment for nocturia if behavioural changes prove ineffective.

When a patient suffers from nocturia, the clinician should also screen for major depressive disorder.

Individuals who suffer from nocturia are more likely to report feelings of anxiety and depression than the general population.

Individuals who suffer from major depressive disorder are more likely suffer from nocturia.

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Sheldon Singh, BSc

Since the mid-19th century, it has been postulated that lithium, a small mono-valent cation, may be useful in the treatment of mania and depression. However, it was not until 1949, when Cade tested the effects of lithium on 10 patients with mania and depression, that its dramatic benefits were noted.¹ Today, lithium is the most extensively studied psychotropic medication. It has remained part of the treatment regimen for mood disorders and is the standard by which newer agents are frequently measured.²

This article will give an overview of the use of lithium in bipolar affective disorder with special consideration to the use of lithium in the elderly population.

Mechanism of Action of Lithium
Bipolar affective disorder or manic-depression is a very serious psychiatric disorder, characterized by abrupt switches from mania to depression. The etiology of this disturbance has not been identified. Research indicates that excess catecholamine activity may be present in the manic phase. It has been postulated that since anticholinergic agents cause mania, a decrease in the cholinergic system may also be involved in the manic phase. However, since the cholinergic system is also implicated in the depressive phase, the exact mechanism of catecholamine and cholinergic involvement in bipolar disorder remains to be elucidated.