What Is Involved in Lithium Therapy?

Jacquelyn Gilchrist

Lithium therapy involves taking lithium carbonate, which is a type of salt, to treat symptoms of certain mental disorders such as bipolar disorder. Some people who take antidepressants to treat depression may also take lithium because the antidepressants may not adequately control their symptoms. Throughout this treatment, patients will need to work closely with their doctors to monitor the correct dosage of the drug and its possible side effects.

Lithium may be used in conjunction with other medications to treat bipolar disorder.
Lithium may be used in conjunction with other medications to treat bipolar disorder.

Bipolar disorder is characterized by cyclical mood changes and other symptoms. Patients in a depressive episode typically have a loss of energy, feelings of depression, and they may experience suicidal thoughts. Those in a manic episode typically experience racing thoughts, and they tend to exhibit impulsive behavior and a need to talk a great deal more than usual. Lithium therapy is used to help control these symptoms to improve the patient's quality of life.

Before prescribing lithium, the doctor will likely require the patient to undergo kidney and thyroid function tests. During treatment, patients should undergo frequent blood testing to prevent lithium toxicity. Most patients will have a drug level between 0.8 to 1.4 milliequivalents per liter (mEq/L) of blood. It is essential to avoid overdosing on lithium, because toxicity can begin at 1.5 mEq/L, or sometimes, at even lower levels.

Patients using lithium therapy should monitor themselves carefully for signs of lithium toxicity, and should get immediate medical help if they experience vomiting, diarrhea, and lack of coordination, which are the early warning signs. As the condition progresses, a patient may notice ringing in the ears, failure of the muscles to work properly, and an unusually large quantity of urine.

Other serious side effects of lithium therapy may include discoloration in the digits, unusual cold sensations, and restless muscle movements. Eye pain, confusion, and fever with muscle stiffness may also occur. Some patients have reported seizures, hallucinations, and fainting as well as light-headedness and a slowed heartbeat.

Special precautions should be followed while using lithium therapy to treat mental disorders. Alcohol and recreational drugs should be avoided, and patients should drink plenty of fluids during exercise and hot weather. They should avoid altering their normal daily intake of salt unless otherwise directed by a physician.

Before beginning lithium therapy, patients must disclose their other medical conditions, medications, and supplements. Women who are pregnant or breastfeeding should not use this drug, and those who are taking it should use birth control. Lithium therapy may be contraindicated for use by those with kidney or heart disease, an underactive thyroid, or organic brain syndrome. This drug may interact with diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), and any antacids that contain sodium bicarbonate.

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Discussion Comments


I'm bipolar II and I have taken lithium for the past twelve years. It quickly made me hypothyroid so I have to take thyroxine as well. I go for regular blood tests, but the longer I stay on lithium, the more I live in fear that it will damage my kidneys, and the other drugs on offer seem to have even worse side effects profiles, so I'm too afraid to change my meds.

The only really positive effect lithium had in the beginning was to take away my suicidal thoughts during my depressive periods (but they have now returned). The other depressive thoughts were not diminished. On top of that, it quickly turned my previously productive hypomanic periods into muted and anxiety-ridden mixed states.

My short term memory has been badly affected. I suffer 'word loss'. My concentration and creativity have been taken away, and I had to give up post-graduate studies as a result. All joy in life has gone.

My hypomania was never considered to be in need of treatment by the medical profession as it wasn't out of control and it allowed me to perform well in both academically and artistically. But as the depressive periods became more severe, the docs could only think of getting rid of the suicidal thoughts, even though I have never even attempted it once.

Since taking lithium I am no longer myself, and even though I am supposed to be in an 'up' stage now, I can honestly say that I would rather have died, because, in a sense, I have.

I do believe that meds are our only salvation, but I think that it's disgraceful that the pharmaceutical companies have only concentrated on treating mania, and have totally neglected the far more serious problem of bipolar depression. I only needed my depression treated. I did not need to have my very self annihilated.

I sometimes think that the medical profession just wants to focus on getting rid of the more publicly-visible manias, and that they don't care about us when we're depressed as we just hide away and no one sees our pain and suffering.

And antidepressants can do terrible harm to many bipolars if prescribed on their own. But I've just been given a prescription for citalopram to treat the anxiety, and I've just seen some research which says that it carries a substantial risk of causing serotonin syndrome if taken with lithium. So what do I do?

In the end it feels as if there is only one thing I can do, and before anyone advises me to get help, I already do. I dutifully take my pills on time and see my psychiatrist regularly, but there is no more that can be done for me. There is no money to provide any kinds of counseling or therapy either.

Thank you for providing a place where I can express my dissatisfaction about the lack of drugs to treat bipolar depression. It has at least made me feel better to talk about it.

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