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Bipolar Disorder Treatment - Lithium

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Lithium Carbonate, known informally as "Lithium," is the oldest treatment for bipolar disorder currently prescribed. In many ways, it remains the best and most effective mood stabilizer available. The American Psychiatric Association recommends lithium as first line therapy for bipolar disorders. Numerous clinical trials have proven its effectiveness for the treatment of bipolar disorder. Although lithium is often used during manic episodes, it is also proven to help patients during depressive episodes.

pile of pills Lithium is usually prescribed in combination with other bipolar medications. This is done because lithium's effects are not instant or quick, but rather take some time to build up. Several days or even weeks may need to pass before lithium's full therapeutic effects are noticeable. Due to this delay, other drugs are frequently administered to handle the acute phases of bipolar disorder mood episodes. Lithium's most common use with regard to bipolar disorder treatment is as a preventative medication. Numerous clinical trials show that lithium is effective in stopping the onset of mood swing episodes, and reduces the frequency of relapses.

Lithium is not a fun medication to take. Typical side effects include:

  • tremors
  • weight gain
  • heavy urination
  • excessive thirst
  • decreased coordination
  • reduced memory and concentration
  • changes in hair quality and quantity
  • nausea or diarrhea
  • decreases in sexual desire and function
  • increase in white blood cells.

Lithium treatment also reduces thyroid function by preventing the release of thyroid hormones. This may make depression worse.

Lithium is also a potentially dangerous drug in that the dose necessary for it to offer antidepressant effects is uncomfortably close to its toxic dose. Toxic levels of lithium in the blood can cause slowed or stopped breathing, seizures, coma and even death.

Before taking lithium, a person will undergo a group of lab tests including:

  • a complete blood count - this measures the number of red and white blood cells and platelets to ensure that these cells are at normal levels, there are no known infections, and that the body can function normally in case of an injury
  • tests for serum creatinine - this is a test of kidney function. Since adequate kidney function is essential to clearing lithium from the system, this test is especially important.
  • tests for electrolytes, hormones, (thyroid, in particular) and urine components - these indicate the basic health of an individual. They also provide baseline levels for comparison during lithium treatment.

To avoid lithium toxicity, people must have regular monitoring of their blood levels of lithium to make sure that they remain within an acceptable range. Blood lithium levels need to be monitored more frequently during the early stages of treatment. As treatment stabilizes, monitoring can occur every three to six months.

As is the case with most medication, care needs to be taken to avoid drug interactions when taking lithium or unanticipated and potentially negative side effects may occur. Patients starting lithium maintenance therapy should make their prescribing psychiatrist aware of any additional medications that they may be taking. Even taking a simple Ibuprofen (e.g., Advil®) can potentially lead to problems. Classes of medications that may interact with lithium include nonsteroidal anti-inflammatory drugs (NSAIDS, including Ibuprofen), anti-hypertension drugs, and antibiotics.

Lithium is by no means the only mood stabilizing medication in use today.

 

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