Optimizing Lithium Treatment
Lithium Treatment for Bipolar Disorder
One of the oldest medicines for bipolar disorder is still a standard treatment, but do lithium's benefits outweigh its risks?
By Regina Boyle Wheeler
Medically Reviewed by Pat F. Bass III, MD, MPH
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After a bipolar disorder diagnosis is made, you and your doctors will decide which medication is best to keep your moods in check. Even though there are many newer bipolar drugs on the market, one of the oldest medications, lithium, is still one of the most commonly prescribed.
Lithium (Eskalith, Eskalith CR, and Lithobid) was the first mood-stabilizing medication to receive government approval in the 1970s and is used primarily to treat bipolar manic episodes. It is also used as a maintenance drug to prevent reoccurrences of mania, the extreme “high” mood of bipolar disorder.
Lithium “continues to be one of the most effective medications for bipolar disorder — about 75 percent of patients have an excellent response,” says Carrie Bearden, PhD, a clinical neuropsychologist and associate professor at UCLA’s Semel Institute for Neuroscience and Human Behavior. “Lithium is helpful in treating both ‘poles’ of bipolar disorder [mania and depression], but it’s probably more effective for the manic/hypomanic side. If someone suffers from primarily bipolar depression, it may not be as effective.”
Lithium has shown to be more effective than other mood stabilizers in the prevention of suicidal behavior in bipolar disorder, according to the American Foundation for Suicide Prevention.
Lithium and Bipolar Disorder: How Does It Work?
Researchers have been investigating how lithium works to stabilize mood for many years. Bearden says scientists still don’t know exactly how it works, but it is believed to help correct a chemical imbalance in the brain by reducing the amount of particular neurochemicals that are recycled in brain cells. The over-active recycling process triggers mania, and lithium helps to stabilize it, Bearden explains.
Bearden says some people show noticeable improvement within a few days of taking lithium, while others notice a more gradual improvement. “Usually those who have a good therapeutic response will continue to find lithium to be effective,” adds Bearden.
Lithium and Bipolar Disorder: Precautions and Side Effects
If you and your doctor decide that lithium is the best option for your bipolar disorder, you’ll have to be closely monitored. Thyroid and kidney function tests are usually done every six months. When treatment is first started, “blood tests will need to be taken weekly so that the right dosage can be determined,” says Bearden. Too little lithium won’t help your symptoms, and too much can lead to lithium toxicity, a potentially serious condition.
According to the National Institutes of Health, patients and caregivers should watch for signs of lithium toxicity such as diarrhea, vomiting, drowsiness, and muscle weakness. If such symptoms appear, discontinue use and call your doctor.
Bearden says some of lithium’s common side effects include mild hand tremors, increased thirst, weight gain, increased urination, occasional stomach cramps and nausea. Lithium can also cause other side effects. If you are experiencing unusual or bothersome side effects, contact your doctor.
Lithium and Bipolar Disorder: During and After Pregnancy
Pregnancy poses a particular problem for women with bipolar disorder. The mood swings associated with having a baby can be a severe problem for someone with a mood disorder. However, many bipolar medications, including lithium, can harm an unborn child.
“Women should not take lithium during the first three months of pregnancy, as it is associated with increased risk of congenital heart abnormalities” in the fetus, says Bearden. But, she adds, it can be taken after the first trimester under a doctor’s close supervision.
“Since lithium passes from the mother’s blood into her breast milk, it’s probably not advisable to take lithium if you are nursing,” Bearden says.
Bearden notes that lithium is a natural element and is not physiologically addictive or habit-forming. With regular monitoring, it’s a safe and effective medication that can help bipolar patients avoid a debilitating mood episode and live a productive life.
Video: Is lithium really the best drug for long term treatment in bipolar disorder?
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