In most depressive disorders, there is only one extreme mood: depression. However, people with bipolar disorder also experience a second extreme mood, called mania. Episodes of mania can be just as disruptive to your life as depression can be. To treat bipolar, it’s equally important that you treat depression and mania.
Lithium is one of the oldest and most successful drugs used to treat the mania and depressive symptoms of bipolar disorder.
Lithium is a mood stabilizer. It comes in an extended-release tablet, immediate-release tablet, capsule, and an oral solution. It’s also fairly inexpensive because it’s available as a generic drug.
Lithium is a mood stabilizer used for long-term treatment of bipolar I disorder. Mood stabilizers are usually a first-line therapy for bipolar disorder. That means they’re the first drugs used for treatment. Lithium treats the manic episodes of bipolar I disorder, which is the more severe of the two types of this disorder. It helps decrease the intensity of manic episodes. It also makes depressive symptoms less severe. Exactly how lithium works to do this is not known, though.
Lithium is very effective. However, the amount of drug needed to be effective is close to the amount that can be poisonous to your body. Taking too much can cause lithium toxicity. Your doctor may slowly change your dosage when you start taking lithium to avoid lithium toxicity. It is very important that you take lithium exactly as your doctor prescribes it. Your doctor will also frequently monitor the levels of lithium in your blood.
Common side effects
Some side effects are more common at standard dosages. Additional side effects are more common at higher dosages. These side effects are listed in the table below.
| Side effects at standard dosages (900–1,800 mg/day) | Additional side effects at higher dosages |
| • fine hand tremor • frequent urination • frequent thirst • nausea • diarrhea • vomiting • drowsiness • muscle weakness • lack of coordination | • giddiness • blurry vision • lack of muscle control during voluntary movements, such as walking and picking things up • ringing sound in your ears |
Rare but serious side effects
Lithium can cause serious side effects in certain people who have other conditions. It can also interact with certain drugs to cause serious side effects. These side effects are rare. Most people who take lithium do not experience them. If you’re concerned about the possibility of these side effects, talk to your doctor.
Lithium may decrease kidney function. If you already have kidney disease, there is a chance that taking lithium could lead to kidney failure. The level of this risk depends on how severe your kidney disease is. This kidney failure is also reversible when you and your doctor stop your treatment with lithium. Your doctor will likely assess your kidney function before prescribing lithium. Make sure your doctor has your complete medical history.
In rare instances, treatment with lithium has triggered Brugada syndrome in people who were predisposed to it. Brugada syndrome is the sudden rapid and uncoordinated opening and closing, or fluttering, of the ventricles of your heart. It is not known why the heart does this. The risk of sudden death from Brugada syndrome is very high. It is most common in men of Southeast Asian origin. Call 9-1-1 or your local emergency services if you take lithium and you experience the following symptoms:
- feeling lightheaded or like you will faint
- heart that feels like it is beating abnormally
- feeling short of breath
In rare cases, people who have taken lithium with other drugs for treating psychiatric disorders have developed brain disease. It is important to discuss with your doctor all the medications that you take as well as over-the-counter drugs and any herbal or vitamin supplements you take. This will help your doctor avoid harmful interactions. Symptoms of brain disease can include weakness, fatigue, fever, confusion, and tremors. If you have these symptoms, call your doctor right away.
Bipolar disorder is a mental illness that causes very quick shifts between the two extreme moods depression and mania. Bipolar disorder usually starts in the late teens or early 20s, usually before the age of 25 years. It’s a lifelong illness, but it can often be managed with the right treatment. Many times, this treatment includes the use of lithium.
Symptoms of depression can include:
- sadness
- lack of interest
- changes in eating habits
- weight loss
- lack of sleep
- tiredness
- trouble concentrating
- suicidal thoughts or behavior
Symptoms of mania can include:
- increased energy
- racing thoughts
- inflated self-esteem
- poor impulse control
- extremely poor judgment
When the changes between these moods are mild, they can make it very hard to live your day-to-day life. They can cause problems in relationships and lead to poor performance in work or school. When these changes are severe, they can lead to suicidal thoughts and even suicidal behaviors.
Lithium is often a part of the lifelong treatment of bipolar disorder. It can be a very effective drug if you take it exactly as your doctor prescribes. However, lithium is not for everyone, and if you don’t take it as your doctor tells you, you could be at risk of lithium toxicity.
To make sure you use lithium as safely and effectively as possible, try these tips:
- Make sure that your doctor has your complete medical history and knows all of the drugs and supplements you take.
- Take the drug exactly as your doctor tells you to.
- Ask your doctor for more information about side effects and discuss your risk.
- Talk to your doctor about any of your concerns about your treatment.