Lithium is a naturally occurring element that was found, in the late 1800s, to have mood stabilizing properties. The first paper on using lithium to treat what was then called manic depression was published in 1949. The FDA approved Lithium in 1970. Even now, the specific way lithium helps people with bipolar disorder is complex and not fully understood.
When Is Lithium Prescribed?Lithium is formally approved to treat manic episodes of bipolar disorder when symptoms such as grandiosity, racing thoughts, hypersexuality, delusions, hallucinations, and decreased need for sleep appear. However, it has also been shown to help with depressive symptoms, psychotic features, and mixed episodes.
Some research has shown that lithium can be effective in treating unipolar depression when added to one or more other depression medications, so it is sometimes prescribed for this use.
When Should Lithium Not Be Prescribed?All patients should be screened for kidney problems before starting the therapy and regularly while taking lithium. If significant kidney problems show up in the initial testing, lithium should be prescribed with great care and close monitoring. If they show up later, your doctor may consider discontinuing lithium.
There are several medical conditions/circumstances that require particular caution when lithium is prescribed:
- Diuretic use
- ACE inhibitor use
- Significant heart or vascular disease
- Severe dehydration; sodium and electrolyte abnormalities
Warnings About LithiumThere are several important warnings for people taking lithium. These include:
- Serum blood level must be monitored regularly. Lithium can be toxic if this gets too high. Symptoms of lithium toxicity include diarrhea, vomiting, tremor, mild problems walking, drowsiness, or muscular weakness. Report such symptoms to a doctor immediately.
- There is a danger of a condition called lithium nephrogenic diabetes insipidus (NDI). If you notice that you are excessively thirsty and are urinating too often, check with a doctor at once.
- If you will be put under an anesthetic - say, for a surgery - make sure the doctors know you are taking lithium.
Precautions When Taking Lithium
- Make sure you maintain normal fluid and salt intake when taking lithium. Dehydration or low levels of sodium in the blood may have serious consequences.
- Prolonged sweating, diarrhea, or a high fever can cause your tolerance to lithium to decrease and may require medical treatment. Check with your doctor if any of these conditions occurs.
- Lithium can cause increased thyroid and parathyroid activity. Your doctor should check blood calcium levels periodically, as these are connected to the workings of the parathyroid gland, as well as for overactive thyroid.
- Calcium channel blockers (may be serious)
- Clozapine (clozaril)
- Cymbalta (duloxetine)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Prozac (fluoxetine) (monitor serum levels closely)
- Risperdal (risperidone)
- Tegretol (carbamazepine) (may be serious)
- Zoloft (sertraline)
- Zyprexa (olanzapine)
- Increased frequency of urination or loss of bladder control
- Increased thirst
- Mild nausea
- Slight trembling of hands
More: Why Does Lithium Make Me Fat?
Pregnancy and NursingLithium is known to cause birth defects, and the risk is increased if another mood stabilizer (such as carbamazepine) is taken with it. If you are of childbearing age, are pregnant, or become pregnant while taking lithium, discuss this with your doctor.
Lithium is excreted in breast milk, so women are advised not to breastfeed infants while taking this medication.
Marples, David. About Lithium NDI. Diabetes Insipidus Foundation. 2003. 10 Mar 2010.
Roxane Laboratories. Lithium Official FDA Information, Side Effects and Uses. Drugs.com. Nov 2009. 10 Mar 2010.
Thomsen HealthCare. Lithium Consumer Information. Drugs.com. Undated. 10 Mar 2010
McKnight RF, Adida, M, Budge, K, Stockton S, Goodwin, GM,Geddes, JR. Lithium toxicity profile: a systematic review and meta-analysis. The Lancet. 20 Jan 2012.