Lithium Therapy for Managing Bipolar Disorder

Lithium is a highly effective treatment for bipolar disorder, though it may carry significant side effects that require careful management.

Dr. Daniel B. Block, MD, is a distinguished, board-certified psychiatrist practicing privately in Pennsylvania.

Lithium is widely prescribed as a mood stabilizer for individuals diagnosed with bipolar disorder. It helps regulate symptoms such as mania, hypomania, depression, and psychosis that are characteristic of this condition.

Discovered in the late 19th century as a naturally occurring element with mood-stabilizing effects, lithium's therapeutic use began gaining recognition after a seminal 1949 study focused on treating manic depression. The U.S. FDA approved lithium for medical use in 1970. Despite decades of use, the precise mechanisms by which lithium benefits bipolar disorder remain complex and not fully elucidated.

When Is Lithium Recommended?

Lithium is officially approved to treat manic episodes in bipolar disorder, addressing symptoms such as inflated self-esteem, rapid thoughts, increased sexual drive, delusions, hallucinations, and reduced need for sleep. Additionally, lithium has proven effective in alleviating depressive symptoms, psychotic features, and mixed mood episodes.

Emerging studies also suggest lithium’s potential in treating unipolar depression when combined with other antidepressants, leading some clinicians to prescribe it for this purpose.

Contraindications and Precautions

Long-term lithium use can adversely affect kidney function. Therefore, patients must undergo kidney function screening before initiating treatment and continue regular monitoring during therapy.

If significant renal impairment is detected initially, lithium should be prescribed cautiously with close supervision. Should kidney issues arise during treatment, discontinuation may be necessary to prevent permanent damage, as some effects may be reversible.

Additional medical conditions and situations requiring caution with lithium include:

Use of ACE inhibitors
Use of diuretics
Severe dehydration or electrolyte imbalances
Serious cardiovascular or vascular diseases

Preliminary research indicates lithium may be safe and effective for treating bipolar symptoms in children and adolescents.

Recognizing Bipolar Disorder Symptoms

Important Lithium Warnings

Key safety considerations for lithium users include:

Regular monitoring of blood lithium levels is essential, as elevated concentrations can lead to toxicity. Overdose symptoms include diarrhea, vomiting, tremors, difficulty walking, drowsiness, and muscle weakness. Immediate medical attention is vital if these occur.
Inform healthcare providers about lithium use prior to any surgery requiring anesthesia.
Lithium is linked to birth defects, especially when combined with other mood stabilizers like carbamazepine. Women of childbearing age should consult their doctor before or during pregnancy. Since lithium passes into breast milk, breastfeeding is generally discouraged during treatment.
Lithium may cause nephrogenic diabetes insipidus (NDI), a rare kidney disorder resulting in excessive urination and thirst. Report such symptoms promptly to your healthcare provider.

Additional Precautions

Consider the following when taking lithium:

Lithium can induce hypothyroidism and hyperparathyroidism; periodic blood tests to monitor thyroid and calcium levels are recommended.
Maintain consistent hydration and sodium intake to prevent complications.
Conditions causing excessive sweating, diarrhea, or fever may reduce lithium tolerance and require medical evaluation.

Medications to Avoid with Lithium

Several drugs may interact adversely with lithium or heighten side effect risks, including many commonly used in bipolar disorder management:

Calcium channel blockers (potentially serious interactions)
Selective serotonin reuptake inhibitors such as Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine)
Antipsychotics like Clozapine (Clozaril), Risperdal (risperidone), and Zyprexa (olanzapine)
Antidepressants like Cymbalta (duloxetine)
Anticonvulsants such as Tegretol (carbamazepine) with serious interaction potential

Patients on lithium should also avoid regular use of NSAIDs (e.g., ibuprofen), diuretics like HCTZ and furosemide, and ACE inhibitors due to interaction risks. Additionally, tetracycline antibiotics may increase lithium levels, while high caffeine intake can reduce them.

Common Side Effects of Lithium

Typical side effects often diminish after initial treatment and include:

Increased urination or bladder control issues
Heightened thirst
Mild nausea
Subtle hand tremors

Weight gain over extended use is also frequently observed.

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7 Trusted References

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Amerio A, Ossola P, Scagnelli F, et al. Systematic review of lithium safety and efficacy in youth bipolar disorder. Eur Psychiatry. 2018;54:85-97. doi:10.1016/j.eurpsy.2018.07.012
Bedford JJ, Weggery S, Ellis G, et al. Amiloride effects on lithium-induced nephrogenic diabetes insipidus. Clin J Am Soc Nephrol. 2008;3(5):1324-1331. doi:10.2215/CJN.01640408
Kibirige D, Luzinda K, Ssekitoleko R. Overview of lithium-induced thyroid disorders. Thyroid Res. 2013;6(1):3. doi:10.1186/1756-6614-6-3
Finley PR. Updated review of lithium drug interactions. Clin Pharmacokinet. 2016;55(8):925-941. doi:10.1007/s40262-016-0370-y

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