{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:04:26Z","timestamp":1782727466437,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,3,25]],"date-time":"2013-03-25T00:00:00Z","timestamp":1364169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Serum lithium levels may be influenced by mood state. We report on a 58\u2010year\u2010old female patient suffering from rapid cycling bipolar disorder. Her serum lithium levels varied greatly, despite stable medication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The patient was observed over a one\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patient received a stable medication of lithium carbonate (450\u00a0mg), valproate (1500\u00a0mg), and clozapine (200\u00a0mg). Investigating mood and serum lithium levels over one year revealed six manic and six depressive phases. The mean lithium serum level was 0.67\u00a0mmol\/L in the depressive states, 0.39\u00a0mmol\/L in the manic states (<jats:italic>t\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>4.11, p\u00a0=\u00a00.001 versus depression), and 0.40\u00a0mmol\/L in the euthymic states (<jats:italic>t\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>3.58, p\u00a0=\u00a00.003 versus depression). Noncompliance was ruled out. The patient gained up to 8\u00a0kg during manic phases, accompanied by pretibial edema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Changes in serum lithium concentration are probably not caused by altered lithium, but by water metabolism. During mania, body water increases, leading to dilution and therefore a reduction in serum lithium levels. As there is no proof for any other known cause of hypervolemia, we propose the hypothesis that the increase in body water is due to a variant of idiopathic edema.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12066","type":"journal-article","created":{"date-parts":[[2013,3,25]],"date-time":"2013-03-25T09:40:40Z","timestamp":1364204440000},"page":"333-337","source":"Crossref","is-referenced-by-count":9,"title":["Mood\u2010dependent changes of serum lithium concentration in a rapid cycling patient maintained on stable doses of lithium carbonate"],"prefix":"10.1111","volume":"15","author":[{"given":"Hans","family":"Rittmannsberger","sequence":"first","affiliation":[{"name":"Department of Psychiatry 1 Landesnervenklinik Wagner\u2010Jauregg Linz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertraud","family":"Malsiner\u2010Walli","sequence":"additional","affiliation":[{"name":"Department of Applied Statistics Johannes\u2010Kepler\u2010University Linz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,3,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200923040-00005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2009.00709.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2005.00199.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2011.00918.x"},{"key":"e_1_2_8_6_1","volume-title":"Manic Depressive Illness. 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