Essential Guide to Safely Using Lithium for Bipolar Disorder

Dr. Steven Gans, a board-certified psychiatrist, actively mentors and teaches at Massachusetts General Hospital.

Lithium is a widely prescribed mood stabilizer designed to prevent and manage manic episodes in individuals diagnosed with bipolar disorder. If you are starting lithium therapy, understanding how to use it safely is crucial. This includes being mindful of potential side effects and the necessity of consistent monitoring through lithium testing labs.

Key Facts About Lithium You Should Know

• Lithium can cause serious adverse effects, and even slight overdoses pose health risks.
• Routine monitoring of lithium blood levels is vital to ensure safe medication use.

Possible Side Effects of Lithium

Like many medications, lithium may lead to various side effects. Some are mild and common, while others are rare but require urgent medical care.

Common Side Effects

Commonly reported side effects are generally manageable and include:

• Skin rashes resembling acne
• Changes in appetite
• Diarrhea
• Dizziness
• Dry mouth
• Increased urination
• Hair thinning or loss
• Tremors in the hands
• Headaches
• Heightened thirst
• Nausea or vomiting
• Swelling or edema

Weight gain is another frequent side effect, typically occurring during the initial two years of treatment. This may be influenced by factors such as concurrent medications, increased consumption of calorie-rich drinks due to thirst, hypothyroidism, or fluid retention.

A 2016 study suggests that Metformin might help mitigate lithium-induced weight gain for some patients.

If these side effects persist or cause discomfort, consult your healthcare provider to discuss possible dosage adjustments or alternative treatments.

Serious Side Effects

More severe side effects require immediate medical attention and include:

• Fainting or loss of consciousness
• Blurred vision
• Chest pain or difficulty breathing
• Confusion or hallucinations
• Slow or jerky movements
• Ringing in the ears or loud internal noises
• Seizures
• Speech difficulties
• Uncontrollable shaking

If you experience any of these symptoms while on lithium, seek emergency care or contact your healthcare provider immediately.

Lithium Toxicity Explained

Excessive lithium levels can lead to toxicity, which manifests in three forms:

• Acute toxicity: caused by a single large overdose.
• Chronic toxicity: results from gradual accumulation over time due to impaired elimination.
• Acute-on-chronic toxicity: occurs when a usual dose is exceeded on a particular day.

Mild toxicity symptoms include weakness, tremors, concentration difficulties, and diarrhea. Severe toxicity may cause vomiting, pronounced tremors, slurred speech, lethargy, and confusion.

Though rarely fatal, lithium toxicity requires prompt medical intervention and may necessitate hospitalization to manage mobility and cognitive issues.

If lithium toxicity is suspected, immediately call the Poison Control Center at 800-222-1222 or seek emergency medical care.

Drugs That Interact With Lithium

Certain medications can increase lithium blood levels, including:

• Angiotensin II receptor blockers (ARBs) like valsartan (Diovan) and losartan (Cozaar)
• ACE inhibitors such as enalapril (Vasotec) and lisinopril (Prinivil)
• Diuretics (water pills)
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve)

Conversely, substances such as caffeine, table salt, and theophylline can lower lithium levels, potentially reducing its effectiveness.

Due to these interactions, your doctor may advise dietary modifications like avoiding low-sodium diets, maintaining adequate hydration, and limiting caffeine intake.

This list is not exhaustive. Always inform your healthcare provider about all medications, supplements, and herbal products you use to avoid harmful interactions.

Monitoring During Lithium Treatment

Maintaining safe lithium levels is essential to protect kidney, parathyroid, and thyroid function. Regular laboratory testing at lithium monitoring facilities is a critical component of treatment.

Many patients experience increased urination after starting lithium; about 15-20% may develop nephrogenic diabetes insipidus (NDI), a condition impairing the kidneys’ ability to concentrate urine, leading to excessive urination and thirst.

How Lithium Levels Are Monitored

Before initiating lithium therapy, kidney and thyroid functions are evaluated. Since lithium is cleared by the kidneys, any impairment can cause dangerous lithium accumulation.

Blood lithium concentrations are checked regularly, especially five days after any dosage adjustment, to ensure levels stabilize within the therapeutic range. Testing is also necessary when starting or stopping other medications.

Monitoring may involve:

• Calcium level assessments to detect lithium’s impact on calcium channels.
• Kidney function tests like eGFR and creatinine measurements.
• Thyroid function tests, crucial for bipolar patients, as thyroid imbalances can influence mood symptoms.

Additional evaluations such as blood chemistry panels and electrocardiograms (EKG) may support safe lithium management.

Therapeutic Lithium Concentrations

Lithium has a narrow therapeutic window, meaning effective and toxic levels are close. Initial therapeutic levels typically range from 0.8 to 1.1 mmol/L, with maintenance levels between 0.6 and 0.8 mmol/L. Elderly patients may require slightly lower targets.

Typical daily lithium doses range from 600 to 1200 mg, though some individuals may need higher amounts to control bipolar symptoms.

Managing Side Effects and Toxicity Risks

Side effects and toxicity can be minimized by maintaining lithium doses at the lower end of the therapeutic range and timing doses appropriately.

Consistent blood level monitoring is essential, especially if new symptoms arise. In some cases, additional medications may be prescribed to alleviate side effects.

Conclusion

Lithium remains a cornerstone treatment for bipolar disorder and has been shown to reduce suicide risk significantly among affected individuals.

If you experience suicidal thoughts, reach out to the National Suicide Prevention Lifeline at 988 for immediate support. In emergencies, call 911.

For further mental health resources, visit the National Helpline Database.

Careful lithium level monitoring is critical to prevent toxicity and protect organ function. While some side effects are common, most are manageable and non-life-threatening.

Regular laboratory testing helps minimize risks to kidneys and thyroid glands. With vigilant monitoring and awareness of early toxicity signs, patients can safely benefit from lithium therapy.

Explore more about bipolar disorder and its treatment in our Conditions A-Z section.

13 References

Verywell Mind relies on peer-reviewed research and expert-reviewed content to ensure accuracy and trustworthiness. Learn more about our editorial standards.

1. National Alliance on Mental Illness. Lithium.
2. Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord. 2016;4(1):27.
3. Praharaj SK. Metformin for lithium-induced weight gain: a case report. Clin Psychopharmacol Neurosci. 2016;14(1):101–103.
4. National Library of Medicine. Lithium.
5. National Library of Medicine. Lithium toxicity.
6. Baird-Gunning J, et al. Lithium poisoning. J Intensive Care Med. 2017;32(4):249-263.
7. Finley P. Drug interactions with lithium: an update. Clin Pharmacokinetics. 2016;55(8):925-41.
8. Gong R, Wang P, Dworkin L. Effects of lithium on the kidney. Am J Physiol Renal Physiol. 2016;311(6):F1168-F1171.
9. Azab AN, et al. Lithium nephrotoxicity. Int J Bipolar Disord. 2015;3(1):28.
10. Nederlof M, et al. Monitoring lithium treatment internationally. Int J Bipolar Disord. 2018;6(1):12.
11. Jakobsson E, et al. Understanding lithium's biological action. J Membrane Biol. 2017;250:587-604.
12. Zhao S, et al. Thyroid function in bipolar disorder. BMC Endocr Disord. 2021;21:210.
13. Del Matto L, et al. Lithium and suicide prevention: a review. Neurosci Biobehav Rev. 2020;116:142-153.

Written by Marcia Purse, a mental health advocate and experienced writer specializing in bipolar disorder.

Discover engaging topics and analytical content in Bipolar Disorder as of 03-07-2023. The article titled " Essential Guide to Safely Using Lithium for Bipolar Disorder " provides new insights and practical guidance in the Bipolar Disorder field. Each topic is meticulously analyzed to deliver actionable information to readers.

The topic " Essential Guide to Safely Using Lithium for Bipolar Disorder " helps you make smarter decisions within the Bipolar Disorder category. All topics on our website are unique and offer valuable content for our audience.