Introduction

At first sight, it may seem incongruous to combine discussions of lithium and L-type calcium-channel blockers in a chapter on treatments for patients with bipolar illness. Whereas lithium is perhaps the best-studied drug for the acute and prophylactic treatment of manic- depressive illness, only a bare minimum of data suggest the potential efficacy of the dihydropyridine L-type calcium-channel blockers. Whereas lithium is a simple heavy metal ion with a panoply of neurochemical actions, the dihydropyridine L-type calcium-channel blockers are complex compounds that act at the cell membrane to regulate intracellular calcium influx through voltage-dependent calcium channels.

Yet, a considerable body of evidence suggests that a variety of lithium's effects also alter intracellular calcium levels and dynamics, and preliminary data suggest that lithium and L-type calcium-channel blockers may have common clinical effects in bipolar patients. Thus, their common and differential pharmacology and side-effects profile allows for an interesting comparative analysis, which is likely to have increasing clinical relevance as the potential role for the L-type calcium-channel blockers in bipolar illness is further elucidated.

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