Lithium and the Treatment of Bipolar Disorder
Since the 1960s, lithium has been the gold standard, treating the range of bipolar symptoms more fully than any other medication in use today. It treats mania. It may treat bipolar depression. It’s also used in maintenance therapy, as long-term medication to prevent or reduce recurrent depressive or manic episodes. And perhaps most importantly, it’s the only medication that’s proven to reduce the risk of suicide associated with bipolar.
Lithium truly is in a league of its own. Interestingly, this wonder med wasn’t cooked up in a multimillion-dollar lab. Lithium is a naturally occurring salt that just happens to reduce a number of mood symptoms when safely managed under a doctor’s care. Downsides include thyroid and kidney problems that may develop with longer term use of lithium.
No one yet fully understands how lithium works in the brain to treat bipolar disorder, but researchers continue to explore a number of possibilities, including effects on cellular signaling (electrochemical messenger systems between and within cells), effects on how genes express different proteins, and neuroprotective effects (improving cells’ recovery from damage). The following table provides a quick rundown of the potential benefits and side effects of this rock star of bipolar disorder medications.
|Generic Name||Brand Names||Typical Adult Dose||Therapeutic Blood Level||Potential Benefits||Some Possible Side Effects*|
Lithium citrate (oral solution)
|600 to 1,800 mg/day, but varies from person to person; blood
level is the more important target.
|0.8 to 1.2 mEq/L for acute mania; may be lower for maintenance
dose; more than 1.5 mEq/L is considered toxic.
|Antimanic; antidepressant; reduces mood cycle frequency;
reduces frequency of suicide.
May reduce long-term cognitive deficits related to bipolar
|Stomach problems; weight gain; frequent urination; kidney
damage; thyroid damage; foggy thinking; fatigue; tremor; dry
mg/day = milligrams per day; mEq/L = milliequivalents per liter.
* Other side effects may occur that aren‘t listed.
You must keep lithium blood levels in a very narrow range, so always take the prescribed dose. Your doctor will test your blood levels every few weeks when you first start taking it and then every several months after the dose is stable. She’ll monitor additional blood and urine tests regularly as well. If lithium dips below its therapeutic level, it may not be effective. If it rises too high, the substance can become toxic, and lithium toxicity can lead to death.
Lithium levels can rise as you lose fluid, so be wary of hot weather and vigorous exercise and limit your consumption of diuretics, including coffee, and alcohol, which can also amplify the sedative effects of lithium. Non-steroidal anti-inflammatory medications (like ibuprofen) can increase lithium levels, too, so check with your doctor before taking any of those meds along with lithium.
Also, don’t make dramatic changes to your salt intake, such as starting a low-salt diet, without consulting your doctor when taking lithium. If you experience diarrhea, vomiting, dizziness, lack of coordination, shakiness, blurred vision, or other signs of lithium toxicity, contact your doctor immediately. If you can’t reach your doctor, head to the nearest emergency room.
All that said, long-term use of lithium provides excellent management of bipolar for some people. Lithium actually prevents the onset of symptoms, so keep taking it even if you’re feeling better. After all, taking lithium is likely what’s making you feel better. Continue to see your doctor regularly to discuss your options in terms of how long you should stay on lithium. Some studies suggest that if you stop taking lithium, it may not be as effective for you if you resume taking it later, although this theory hasn’t been clearly proven.
On the web or at your local health food store, you may hear about lithium orotate, which is purported to be safer. But no reliable studies currently support the claim that lithium orotate is safer than or as effective as lithium carbonate. With any form of lithium, you and your doctor need to carefully monitor your blood levels throughout treatment.