Lithium (A complete guide)

Lithium

Lithium is a long-term treatment used for episodes of mania and depression.

In this blog article, we will discuss what lithium is used for, how it works to treat bipolar disorder and depression, and common side effects. 

What is lithium? 

Lithium is an element which gets its name from “lithos” the Greek word for stone, because it is present in trace amounts in almost all rocks.

How does lithium work?

Lithium (Eskalith, Lithobid) is one of the most widely used and studied medications for treating mania that is part of bipolar disorder (manic-depressive illness).

It is also used on a daily basis to reduce the frequency and severity of manic episodes.

Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (eg, unusual anger or irritability or a false sense of well-being) to depression or sadness.

Studies show that lithium can significantly reduce suicide risk.

It is not known how lithium works to stabilize a person’s mood. However, it does act on the central nervous system.

It helps one have more control over emotions and helps one cope better with the problems of living.

Lithium (A complete guide)

Lithium is used on a daily basis to reduce the frequency and severity of manic episodes.

What are common side effects of lithium? 

Most people who take lithium have no side effects, and it is safe.

However, in less common cases lithium can cause:

·      nausea

·      diarrhea

·      dizziness

·      change in heart rhythm

·      muscle weakness

·      fatigue

·      a dazed feeling.

These unwanted side effects often improve with continued use.

With continued use there is evidence of the following occurring and persisting:

·      fine tremor

·      frequent urination

·      thirst

·      weight gain

·      swelling from excess fluid.


Lithium can also cause or worsen skin disorders such as acne, psoriasis and rashes. It can also cause problems with the thyroid gland.

The amount of lithium in the body must be carefully controlled and monitored with blood tests.

What is Lithium prescribed for?

Lithium is a long-term treatment for episodes of mania and depression. It’s usually prescribed for at least six months.

The primary condition of people with these symptoms treatable by lithium is bipolar disorder.

The other main target is people with depression who are non-responsive to any other medication.

Bipolar disorder is a brain disorder that causes extreme shifts in mood, energy, and activity levels, and severely interferes with everyday life. 

Symptoms of bipolar disorder include both manic and depressive episodes. Up and down, plus and minus. 

The following are symptoms of a depressive episode: 

·      feelings of sadness, emptiness or hopelessness 

·      very low energy and activity levels 

·      trouble sleeping (either sleeping too much or too little) 

·      loss of enjoyment in hobbies or activities

·      feelings of worry 

·      trouble concentrating and trouble remembering things 

·      changes in appetite (either eating too much or too little)

·      feeling sluggish 

·      thoughts of death or suicide.

Lithium (A complete guide)

Signs of a manic episode are: 

·      feeling very “up” or elated

·      increased energy and activity levels

·      feeling jumpy or wired 

·      trouble sleeping (insomnia)

·      talking very fast about a lot of different things

·      agitation or irritability

·      thoughts racing 

·      think they can do a lot of things at once 

·      taking risks such as spending a lot of money or having reckless sex.

If you or someone you know is having thoughts of suicide, seek help immediately. 

There are two main types of bipolar disorder: Bipolar I Disorder and Bipolar II Disorder. 

Bipolar I Disorder is defined by manic episodes that last at least 7 days, or severe manic symptoms that require immediate hospitalization.

Depressive episodes occur as well and usually last at least 2 weeks. Bipolar I Disorder patients may also have mixed episodes with both manic and depressive symptoms simultaneously. 

Bipolar II Disorder is characterized by a pattern of depressive episodes and hypomanic episodes.

Hypomanic episodes have some features of typical manic episodes, but are not severe enough to be considered manic. 

Lithium (A complete guide)

Signs of a manic episode are feeling very up or elated.

In addition to people with bipolar disorder, people who are depressed and have not been responding to other treatments may be prescribed lithium.

Lithium can improve mood and decrease suicidal thoughts in these patients. 

Major depressive disorder (MDD) is a mood disorder that causes feelings of worthlessness and loss of interest in daily activities.

Common symptoms of MDD are as follows: 

·      chronic feelings of sadness, tearfulness, emptiness, or hopelessness

·      loss of interest in activities that once used to bring enjoyment (e.g. sex, hobbies) 

·      outbursts of anger and irritability

·      frustration

·      issues with sleeping too much or insomnia

·      lack of energy and fatigue 

·      changes in eating patterns and weight (i.e., increased appetite and weight gain or reduced appetite and weight loss)

·      anxiety

·      agitation

·      restlessness

·      slowed speaking, thinking or movement 

·      feelings of worthlessness 

·      ruminating on past failures

·      feelings of guilt 

·      trouble concentrating, making proper decisions, and remembering things

·      physical problems such as back pain or headaches that cannot be explained by another medical condition.

To get more insight into depression, click here. 

Frequently asked questions (FAQs) about Lithium:

1.    What is the drug lithium used for?

Lithium is used to treat the manic episodes in people with bipolar disorder.

These symptoms include hyperactivity, very fast speech, poor judgement, little need for sleep, aggression and anger. 

2.    What are the most common side effects of lithium?

There are many side effects that people who take lithium may experience.

These include the following:

·      hand tremors

·      increased urination

·      thirst

·      gastrointestinal disturbances such as diarrhea and vomiting

·      drowsiness

·      muscle weakness

·      lack of coordination .

3.    What happens if you take lithium?

Experts are not sure exactly how lithium works but believe it alters sodium transport in nerve and muscle cells which adjusts the metabolism of neurotransmitters within the cell.

Lithium is an element found naturally in the environment and in our bodies.

4.    What kind of drug is lithium?

Lithium belongs to the class of medicines known as antimanic agents.

5.    Does lithium make you sleepy?

Lithium may affect your mental alertness or make you drowsy.

You should avoid driving or operating any machinery if you feel drowsy.

6.    How quickly does lithium work?

Lithium is completely absorbed in the gastrointestinal tract with peak levels occurring 0.25 to three hours after oral administration of immediate-release preparations and two to six hours after sustained-release preparations.

A reduction in manic symptoms should be noticed within one to three weeks.

7.    Does lithium cause weight gain?

The mood-stabilizing drug lithium remains an effective mainstay of treatment for bipolar disorder, but unfortunately, it can cause weight gain.

Although the possibility of gaining weight while taking lithium is a well known problem, this side effect does not affect everyone who takes the medication

A reduction in manic symptoms should be noticed within one to three weeks.

8.    Does lithium help with irritability?

Lithium can treat symptoms of bi-polar disorder and help correct the chemical imbalance that led to the disorder in the first place.

Although some people who take lithium report increased episodes of irritability and anger, this isn’t considered a side effect of the medication.

9.    What happens if you drink alcohol while taking lithium?

Alcohol can increase the nervous system side effects of lithium such as dizziness, drowsiness, and difficulty concentrating.

Some people may also experience impairment in thinking and judgment.

You should avoid or limit the use of alcohol while being treated with lithium.

10.         How is lithium intake monitored?

A lithium level should be taken no earlier than five to seven days after starting treatment.

The level should be a 12 hour trough i.e. taken approximately 12 hours after the last dose of lithium.

In twice daily dosing the morning dose should be withheld until the level has been taken.

Subsequent levels should then be taken no earlier than five to seven days after every dose change until the patient is stable and the target level is achieved.

The target level for new lithium patients is between 0.6 – 0.8mmol/L.

Lithium (A complete guide)

If you want to read further about lithium and bipolar disorder try these books:

Odes to Lithium

In this remarkable debut, Shira Erlichman pens a love letter to Lithium, her medication for Bipolar Disorder.

With inventiveness, compassion, and humor, she thrusts us into a world of unconventional praise.

From an unexpected encounter with her grandmother’s ghost, to a bubble bath with Bjӧrk, to her plumber’s confession that he, too, has Bipolar, Erlichman buoyantly topples stigma against the mentally ill.

These are necessary odes to self-acceptance, resilience, and the jagged path toward healing.

With startling language, and accompanied by her bold drawings and collages, she gives us a sparkling, original view into what makes us human.

Lithium: A Doctor, a Drug, and a Breakthrough

From insulin comas and lobotomy to incarceration and exile, Walter Brown chronicles the troubling history of the diagnosis and (often ineffective) treatment of bipolar disorder through the centuries, before the publication of a groundbreaking research paper in 1949.

Cade’s “Lithium Salts in the Treatment of Psychotic Excitement” described, for the first time, lithium’s astonishing efficacy at both treating and preventing the recurrence of manic-depressive episodes, and would eventually transform the lives of patients, pharmaceutical researchers, and practicing physicians worldwide.

And yet, as Brown shows, it would be decades before lithium would overcome widespread stigmatization as a dangerous substance, and the resistance from the pharmaceutical industry, which had little incentive to promote a naturally occurring drug that could not be patented.

Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner

Maintaining a relationship is hard enough without the added challenges of your partner’s bipolar disorder symptoms.

Loving Someone with Bipolar Disorder offers information and step-by-step advice for helping your partner manage mood swings and impulsive actions, allowing you to finally focus on enjoying your relationship while also taking time for yourself.

This book explains the symptoms of your partner’s disorder and offers strategies for preventing them and responding to these symptoms when they do occur.

Bipolar Disorder For Dummies

When one receives the diagnosis that they or a loved one has bipolar disorder, it can be a time of fear and worry.

Bipolar Disorder For Dummies,3rd Edition explains the brain chemistry behind the disease and covers the latest medications and therapies.

You’ll get reassuring, sound advice and self-help techniques that you and your loved ones, including kids and teens, can use to ease and eliminate symptoms, function in times of crisis, plan ahead for manic or depressive episodes and feel a whole lot better.

This new edition will include new and updated content on genetics, biochemistry and imaging studies relevant to bipolar, expanded coverage on how to handle the high costs of treatment, and supporting a loved one (who may not want help), medications and treatment options, including DSM-5, ECT, and TMS along with new coverage on special populations (how bipolar affects different groups, like women and various ethnic groups and special populations, like seniors and expectant moms).

References:

Lithium – WebMD – January 2020

Lithium Good Practice Standards – NHS – July 2015

Lithium (Oral Route) – Mayo Clinic – March 2020 

Lithium (A complete guide)

Aura Des los Santos

Aura Des los Santos is a Clinical Psychologist with two masters degree in Education. One focused in Higher Educacion and the other in the research of Psychology of Education. Her experience is focused on working depression, anxiety and personal development. She frequently writes articles in the area of psychology, education, travel and general culture.