People are often frightened when the doctor raises the possibility of lithium treatment – it conjures up all kinds of images from the media and Hollywood of dark, dangerous institutions and wild kinds of symptoms. Patients often look surprised when I mention it – saying, “but isn’t that for only really crazy people?” It is unfortunate that lithium has gotten such a bad rap, because it is one of our best tested, longest used (since the 1960s), and most effective interventions for bipolar disorder. Here’s a list of its many benefits:

• It treats mania.
• It treats depression.
• It can reduce the cycling of both mania and depression.
• It’s the only medication that’s proven to reduce the risk of suicide in bipolar disorder.

There was a long period of time in recent history when doctors were leaning toward using the newer medications to treat mania and bipolar disorder, but as experiences with those medicines have revealed a number of difficult side effects, psychiatrists are moving back to the old standby – lithium. While lithium has its own side effects, they are well defined and can often be reduced or eliminated with adjustments and modifications to dose or other straightforward interventions. Following are the most common side effects:

• Stomach problems
• Weight gain
• Frequent urination
• Kidney damage
• Liver damage
• Foggy thinking
• Fatigue
• Tremor

Lithium wasn’t cooked up in a multimillion-dollar lab. It is a naturally occurring salt that just happens to calm the nerves and, when used under a doctor’s supervision, has manageable side effects for most people. Because it is often effective in managing both “poles” of bipolar – mania and depression – it is one of the rare medications that is truly a mood stabilizer for many people.

One of the biggest challenges with lithium is that blood levels (the concentration of lithium in the blood) must be maintained in a very narrow range. If your lithium level dips below its therapeutic level, the drug isn’t effective. If it rises too high, the drug can become toxic, and severe lithium toxicity can lead to death. So remember:

• Always take the prescribed dose. Appropriate doses can vary widely from person to person – even people of similar weights. The blood level is the important number in the case of lithium. So don’t worry if your dose is very different from someone else you know?
• Make sure your doctor prescribes regular blood tests to check your lithium levels – at least every few months (more regularly when you first start taking it). The “right level” is typically between 0.6 and 1.2 mmol/litre but every lab has a slightly different range. And while most people require a level in this range, some people do well in a lower range.
• Your doctor may also order additional blood and urine tests particularly to check on your thyroid and kidney functions.
• Lithium levels can rise as you lose fluid, so be wary of hot weather and vigorous exercise, and limit your consumption of diuretics, including coffee and alcohol.
• If you experience diarrhea, vomiting, dizziness, lack of coordination, blurred vision, or other signs of lithium toxicity, contact your doctor immediately. If you can’t reach your doctor, head to the nearest emergency room.

Warning: On the Web or at your local health food store, you may hear of a form of lithium purported to be safer: lithium orotate. The theory behind this claim is that the chemical compound delivers lithium to the brain more efficiently than lithium carbonate, the standard compound, so it requires less lithium in your bloodstream to be effective. However, no studies currently show that lithium orotate is effective in treating mania or depression. Taking the recommended dose of lithium orotate probably won’t harm you but it also won’t help.

If you’ve taken lithium for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.

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From Psych Central's World of Psychology:
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    Last reviewed: 18 Jul 2008