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Lithium effects on body


Lithium: medicine to control mood disorders such as mania and bipolar disorder

1. About lithium

Lithium is a type of medicine known as a mood stabiliser.

It's used to treat mood disorders such as:

  • mania (feeling highly excited, overactive or distracted)
  • hypo-mania (similar to mania, but less severe)
  • regular periods of depression, where treatment with other medicines has not worked
  • bipolar disorder, where your mood changes between feeling very high (mania) and very low (depression)

Lithium can also help reduce aggressive or self-harming behaviour.

It comes as regular tablets or slow-release tablets (lithium carbonate). It also comes as a liquid that you swallow (lithium citrate).

Lithium is available on prescription.

2. Key facts

  • The most common side effects of lithium are feeling or being sick, diarrhoea, a dry mouth and a metallic taste in the mouth.
  • Your doctor will carry out regular blood tests to check how much lithium is in your blood. The results will be recorded in your lithium record book.
  • Lithium carbonate is available as regular tablets and modified release (brand names include Priadel, Camcolit and Liskonium).
  • Lithium citrate comes as a liquid and common brands include Priadel and Li-Liquid.

3. Who can and cannot take lithium

Lithium can be taken by adults and children over the age of 12 years.

Lithium may not be suitable for some people. Tell your doctor if:

  • you have ever had an allergic reaction to lithium or other medicines in the past
  • you have heart disease
  • you have severe kidney problems
  • have an underactive thyroid gland (hypothyroidism) that is not being treated
  • you have low levels of sodium in your body – this can happen if you're dehydrated or if you're on a low-sodium (low-salt) diet
  • you have Addison's disease, a rare disorder of the adrenal glands
  • you have, or someone in your family has, a rare condition called Brugada syndrome – a condition that affects your heart
  • you need to have surgery in hospital
  • you are trying to get pregnant, are pregnant or breastfeeding

Before prescribing lithium, your doctor will do some blood tests to check your kidney and thyroid are OK. The doctor will also check your weight (and check this throughout your treatment).

If you have a heart condition, the doctor may also do a test that measures the electrical activity of your heart (electrocardiogram).

4. How and when to take lithium

It's important to take lithium as recommended by your doctor.

There are 2 different types of lithium – lithium carbonate and lithium citrate. It's important not to change to a different type unless your doctor has recommended it. This is because different types are absorbed differently in the body.

Lithium carbonate comes as regular tablets and slow-release tablets – where the medicine is released slowly over time.

Lithium citrate comes as a liquid. This is usually only prescribed for people who have trouble swallowing tablets .

Doses vary from person to person. Your starting dose will depend on your age, what you're being treated for and the type of lithium your doctor recommends.

If you have kidney problems your doctor will monitor the level of lithium in your blood even more closely and change your dose if necessary.

You will usually take your lithium once a day, at night. This is because when you have your regular blood test, you need to have it 12 hours after taking your medicine. You can choose when you take your lithium – just try to keep to the same time every day.

How to take it

Swallow tablets whole with a drink of water or juice. Do not chew them. You can take lithium with or without food.

If you're taking liquid, use the plastic syringe or spoon that comes with your medicine to measure the correct dose. If you do not have one, ask your pharmacist. Do not use a kitchen teaspoon as you will not get the right amount.

Information about your lithium treatment

When you start taking lithium, you will get a lithium treatment pack (usually a purple folder or book) with a record booklet. You need to show your record booklet every time you see your doctor, go to hospital, or collect your prescription.

When you go to the doctor for blood tests, you or your doctor will write in the record booklet:

  • your dose of lithium
  • your lithium blood levels
  • any other blood test results
  • your weight

The treatment pack also has a lithium alert card. You'll need to carry this card with you all the time. It tells healthcare professionals that you're taking lithium. This can be useful for them to know in an emergency.

Tell your doctor or pharmacist if you've lost your treatment pack or did not get one.

Will my dose go up or down?

When you start your treatment you'll need to have a blood test every week to make sure the level of lithium in your blood is not too high or too low. Your doctor may change your dose depending on the results of your blood test.

Once the doctor is happy you'll have a blood test every 3 to 6 months to check the level remains steady.

Once you find a dose that suits you, it will usually stay the same – unless your condition changes, or your doctor prescribes another medicine that may interfere with lithium.

Important

Do not stop taking lithium suddenly or change your dose without speaking to your doctor first. It's important you keep taking it, even if you feel better. If you stop taking it suddenly you could become unwell again very quickly.

What if I'm ill while taking lithium?

Infections and illnesses like colds and flu can make you dehydrated, this can affect the level of lithium in your blood.

Talk to your doctor or pharmacist if you:

  • have an illness that causes severe diarrhoea, vomiting, a high temperature or sweating
  • have a urinary tract infection (UTI)
  • are not eating and drinking much

What if I forget to take it?

If you usually take:

  • tablets or slow-release tablets – if it's less than 6 hours since you were supposed to take your lithium, take it as soon as you remember. If it is more than 6 hours, just skip the missed dose and take your next one at the usual time
  • liquid – if you forget to take a dose, just skip the missed dose and take your next one at the usual time

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Immediate action required: Call 999 or go to A&E if:

  • you take too much lithium, even if you do not feel any different

This is because very high amounts of lithium can cause problems with your kidneys and other organs. It can cause symptoms such as:

  • feeling or being sick
  • problems with your eyesight (blurred vision)
  • increased need to pee, lack of control over pee or poo
  • feeling faint, lightheaded or sleepy
  • confusion and blackouts
  • shaking or muscle weakness, muscle twitches, jerks or spasms affecting the face, tongue, eyes or neck

If you need to go to A&E, take the lithium packet or the leaflet inside it, plus any remaining medicine, with you.

5. Side effects

If you're on the right dose and the level of lithium in your blood is right, you may not have any problems taking this medicine.

However, some people find lithium slows down their thinking or makes them feel a bit "numb".

Common side effects

These are usually mild and go away by themselves. They are more likely to happen when you start taking lithium.

Keep taking the medicine but talk to your doctor or pharmacist if any of the following side effects get worse or do not go away after a few days:

  • feeling sick (nausea)
  • diarrhoea
  • a dry mouth and/or a metallic taste in the mouth
  • feeling thirsty and needing to drink more and pee more than usual
  • slight shaking of the hands (mild tremor)
  • feeling tired or sleepy
  • weight gain (this is likely to be very gradual)

Serious side effects:

The level of lithium in your blood is checked regularly. But rarely, you may get side effects because there's too much lithium in your blood.

Immediate action required: Call 999 or go to A&E now if:

You have 1 or more of these symptoms:

  • loss of appetite, feeling or being sick (vomiting)
  • problems with your eyesight (blurred vision)
  • feeling very thirsty, needing to pee more than normal, and lack of control over pee or poo
  • feeling lightheaded or drowsy
  • confusion and blackouts
  • shaking, muscle weakness, muscle twitches, jerks or spasms affecting the face, tongue, eyes or neck
  • difficulty speaking

These are signs of lithium toxicity. Lithium toxicity is an emergency. Stop taking lithium straight away.

How to avoid high lithium levels in your blood

Make sure that you go for the blood tests arranged by your doctor.

It's important not to reduce your salt intake suddenly. Talk to your doctor if you want to reduce the amount of salt in your diet.

Drink plenty of fluids, especially if you are doing intense exercise or in hot weather when you will sweat more.

Drinking alcohol causes your body to lose water. It's best not to drink too much as it's likely to make you dehydrated, especially in hot weather when you will sweat more.

Always tell any doctor or pharmacist that you are taking lithium before you take any new medicines.

Serious allergic reaction:

In rare cases, lithium may cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of lithium. For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • feeling or being sick – take lithium with or after a meal or snack. It may also help if you do not eat rich or spicy food. If you are being sick, take sips of water to avoid dehydration.
  • diarrhoea – drink plenty of fluids to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
  • a dry mouth and/or a metallic taste in the mouth – try sugar-free gum or sweets, or sipping cold drinks. If this does not help, talk to your pharmacist or doctor. Try not to have drinks with a lot of calories in as this might also mean you put on weight.
  • slight shaking of the hands (mild tremor) – talk to your doctor if this is bothering you or does not go away after a few days. These symptoms can be a sign that the dose is too high for you. Your doctor may change your dose or recommend taking your medicine at a different time of day.
  • feeling tired or sleepy – as your body gets used to lithium, these side effects should wear off. If these symptoms do not get better within a week or two, your doctor may either reduce your dose or increase it more slowly. If that does not work you may need to switch to a different medicine.
  • weight gain – try to eat well without increasing your portion sizes so you do not gain too much weight. Regular exercise will help to keep your weight stable and help you feel better.

7. Pregnancy and breastfeeding

Lithium and pregnancy

Lithium is not usually recommended in pregnancy, especially during the first 12 weeks (first trimester) where the risk of problems to the baby is highest. However, you may need to take lithium during pregnancy to remain well. Your doctor may advise you to take it in pregnancy if the benefits of the medicine outweigh the risks.

If you become pregnant while taking lithium, speak to your doctor. It could be dangerous to you and your unborn baby if you stop taking it suddenly. Do not stop taking it or make any change to your dose unless your doctor tells you to.

Talk to your doctor before taking this medicine if you plan to get pregnant, or think you may be pregnant. Your doctor can explain the risks and the benefits and will help you decide which treatment is best for you and your baby.

Lithium and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take lithium while breastfeeding.

Lithium passes into breast milk in small amounts. However, it has been linked with side effects in very few breastfed babies.

It's important to continue taking lithium to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.

Non-urgent advice: Talk to your doctor if you:

  • are trying to get pregnant
  • are already pregnant
  • would like to breastfeed

For more information about how lithium can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

8.

Cautions with other medicines

This are some medicines that may interfere with how lithium works and this can affect the levels of lithium in your blood.

Check with your doctor or pharmacist if you're taking (or before you start taking):

  • tablets that make you pee (diuretics) such as furosemide or bendroflumethiazide
  • non-steroidal anti-inflammatory drugs (NSAIDs) – used for pain relief and swelling such as aspirin, ibuprofen, celecoxib or diclofenac
  • medicines used for heart problems or high blood pressure such as enalapril, lisinopril or ramipril (ACE inhibitors)
  • some medicines used for depression such as fluvoxamine, paroxetine or fluoxetine
  • antibiotics such as oxytetracycline, metronidazole, co-trimoxazole, trimethoprim
  • medicines for epilepsy such as carbamazepine or phenytoin

These are not all the medicines that can affect the way lithium works. Always check with your doctor before you start or stop taking any medicine.

Mixing lithium with herbal remedies or supplements

It's not possible to say whether complementary medicines and herbal supplements are safe to take with lithium.

They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does lithium work?

Lithium is a metal. Tiny amounts of lithium are found naturally in rocks, and in our food and bodies.

We do not really know exactly how lithium works for mental health conditions, though we do know it's very effective.

There are a number theories about how it works. One is that it works by protecting and helping to create neurons (the cells that pass messages in your brain).

How long does it take to work?

Lithium may take several weeks or months to work.

How will it make me feel?

If the amount of lithium in your blood is right, you probably will not have any problems taking this medicine.

However, some people find it slows down their thinking or makes them feel a bit "numb". Sometimes it's hard to know whether this is because the lithium is doing its work to control your mood (if you have mania).

Talk to your doctor if you're worried that lithium is slowing down your thinking or numbing your emotions. You may need to have your lithium levels checked again.

How long will I take it for?

As long as it is working well to control your condition, you will generally take lithium for a long time.

Some people need to take lithium for many years.

What will happen if I stop taking it?

If you or your doctor decide to stop lithium, it must be reduced gradually over a number of weeks or months. If you stop taking it suddenly the symptoms of your condition are likely to come back.

Do not stop taking lithium suddenly even if you feel better, or because you think the dose is too little or too much.

Your doctor will help you to reduce your medicine and stop completely, if you need to.

However, if you think you have lithium toxicity, or are having an allergic reaction, it's important to stop taking lithium straight away and get medical help.

Immediate action required: Call 999 or go to A&E now (and stop taking lithium) if:

  • you’re having an allergic reaction
  • you have lithium toxicity
Can I take lithium for a long time?

Lithium is generally safe to take for a long time. Most people take it for years with no problems.

If you've been taking lithium for some time, it can cause weight gain. It can also cause problems with your kidneys or thyroid gland.

Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. Signs of kidney problems include swollen hands or ankles, feeling tired and short of breath, changes in your pee and feeling sick. Tell your doctor if you get any these symptoms. Your doctor will test your thyroid and kidneys every 6 months to check for any changes.

If you find you're putting on weight after taking lithium for a while, try to have a healthy balanced diet. Regular exercise will also help you keep your weight stable. Your doctor will usually monitor your weight while you're taking this medicine.

Your doctor may discuss topping up levels of the hormone that the thyroid gland normally produces (thyroxine) with a tablet.

Is lithium an antipsychotic?

Lithium is not an antipsychotic medicine, it's known as a mood stabiliser. However, your doctor might prescribe an antipsychotic medicine with lithium.

How well does lithium treat depression?

Usually, if you have depression, you'll be prescribed an antidepressant medicine first as they are considered more effective for depression than lithium.

However, when antidepressants have not worked, your doctor might prescribe lithium as well. This may be more effective and help your symptoms get better.

Can I drink alcohol with it?

Lithium can make you drowsy so it's best to stop drinking alcohol during the first few days of taking lithium, or if your dose is increased.

If you feel OK after this, you can drink alcohol but it's best not to drink too much it's likely to make you dehydrated. This can increase the chance of high levels of lithium in your blood. It's important to remember this, especially in hot weather when you will sweat more and your body loses water.

Will it affect my contraception?

Lithium does not affect contraception including the combined pill or emergency contraception.

However, if you have severe diarrhoea for more than 24 hours, your combined pill may not protect you from pregnancy. Look on the pill packet to find out what to do.

Read more about what to do if you're on the pill and you have diarrhoea

Will it affect my fertility?

There is no clear evidence that lithium affects female fertility. However, there is small chance that it can reduce sperm count in men.

Speak to your doctor if you're trying for a baby.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking lithium.

However, it's best to avoid a low-sodium (low-salt) diet as this can increase the levels of lithium in your blood and increase the chance of getting side effects.

The amount of fluids you drink is very important as it can affect the levels of lithium in your blood. Getting dehydrated will affect the levels so it's good to drink plenty of fluids.

Some people may put on weight when taking lithium. Try to eat well without increasing your portion sizes. Regular exercise can also help to keep your weight stable.

Can I drive or ride a bike?

When you first start taking lithium – or if the dose has recently been changed – it may make you feel tired, dizzy, sleepy and make your hands shake.

This could affect you if you drive a car, ride a bike, or do anything else that needs focus.

You're recommended to stop doing these things for the first few days, until you know how lithium affects you and until you feel more alert.

If you have been diagnosed with bipolar disorder you must tell the Driver and Vehicle Licensing Agency (DVLA).

Can I take lithium with recreational drugs?

Using recreational drugs can affect the level of lithium in the body.

Taking ecstasy while you're on lithium can make you dehydrated, which can lead to lithium toxicity.

Tell your doctor if you think you may take recreational drugs while you're on lithium.

NAMI: National Alliance on Mental Illness

Brand names:

  • Lithium
    • Immediate release tablets: 300mg
    • Immediate release capsules: 150 mg, 300 mg, 600 mg
    • Oral solution (liquid): 8 mEq/5 mL
  • Lithobid®
    • Tablets (extended release): 300 mg, 450 mg
  • Eskalith®, Eskalith CR®: discontinued

Generic name: lithium (LITH ee um)

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Lithium And What Does It Treat?

Lithium is a mood stabilizer medication that works in the brain. It is approved for the treatment of bipolar disorder (also known as manic depression). Bipolar disorder involves episodes of depression and/or mania.

Symptoms of depression include:

  • Depressed mood — feeling sad, empty, or tearful
  • Feeling worthless, guilty, hopeless, or helpless
  • Loss of interest or pleasure in normal activities
  • Sleep and eat more or less than usual (for most people it is less)
  • Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
  • Psychomotor agitation (‘nervous energy’)
  • Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

  • Feeling irritable or “high”
  • Having increased self esteem
  • Feeling like you don’t need to sleep
  • Feeling the need to continue to talk
  • Feeling like your thoughts are too quick (racing thoughts)
  • Feeling distracted
  • Getting involved in activities that are risky or could have bad consequences (e. g., excessive spending)

Lithium may also be helpful when prescribed “off-label” for depression, especially when combined with antidepressant medications. “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

What Is The Most Important Information I Should Know About Lithium?

Bipolar disorder requires long-term treatment. Do not stop taking lithium, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine. Missing doses of lithium may increase your risk for a relapse in your mood symptoms.

Do not stop taking lithium or change your dose without talking to with your healthcare provider first.

In order for lithium to work properly, it should be taken every day as ordered by your healthcare provider.

Periodically, your healthcare provider may ask you to provide a blood sample to make sure the appropriate level of medication is in your body and to assess for side effects, such as changes in blood cell counts or kidney function.

Are There Specific Concerns About Lithium And Pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Lithium has been associated with an increased risk of Ebstein’s anomaly, a heart valve defect. Even though data suggest that the risk of Ebstein’s anomaly from first trimester use of lithium is very low, an ultrasound of the heart is recommended at 16 to 20 weeks of gestation. Lithium levels should be monitored monthly in early pregnancy and weekly near delivery. Do not stop taking lithium without first speaking to your healthcare provider. Discontinuing mood stabilizer medications during pregnancy has been associated with a significant increase in symptom relapse.

Regarding breast-feeding, caution is advised since lithium does pass into breast milk. In general, breastfeeding is not recommended while taking lithium.

What Should I Discuss With My Healthcare Provider Before Taking Lithium?

  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any other psychiatric or medical problems you have
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you drink alcohol or use illegal drugs

How Should I Take Lithium?

Lithium is usually taken 1-3 times per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 600 mg to 1200 mg daily, but some people may require higher doses depending on weight or symptoms. Only your health care provider can determine the correct dose for you.

Extended release tablets: Swallow the tablet whole. Do not crush or chew extended release tablets.

Liquid: Measure with a dosing spoon or oral syringe, which you can get from your pharmacy.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Lithium?

If you miss a dose of lithium, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your dose or take more than what is prescribed.

What Should I Avoid While Taking Lithium?

Avoid drinking alcohol or using illegal drugs while you are taking lithium. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

Avoid low sodium diets and dehydration because this can increase the risk of lithium toxicity.

Avoid over the counter and prescription pain medications that contain nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Motrin®, Advil®) or naproxen (Aleve®, Naprosyn®) because these medications can increase the risk of toxicity from lithium.

Avoid excessive intake of caffeinated beverages, such as coffee, tea, cola or energy drinks, since these may decrease levels of lithium and decrease effectiveness of the medication. Discontinuing caffeine use may increase lithium levels. Consult your healthcare provider before reducing or stopping caffeine use.

What Happens If I Overdose With Lithium?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of lithium does not exist, but there are treatments to decrease the effects of the medication. Only a doctor can determine if you require treatment.

What are possible side effects of lithium?

Common side effects

  • Headache
  • Nausea or vomiting
  • Diarrhea
  • Dizziness or drowsiness
  • Changes in appetite
  • Hand tremors
  • Dry mouth
  • Increased thirst
  • Increased urination
  • Thinning of hair or hair loss
  • Acne-like rash

Rare/serious side effects

Signs of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, vision changes, and unsteadiness while standing or walking. These symptoms need to be addressed immediately with a medical doctor to ensure your lithium level is not dangerously high.

In rare cases, lithium may lead to a reversible condition known as diabetes insipidus. If this occurs you would notice a significant increase in thirst and how much fluid you drink and how much you urinate. Talk to your doctor if you notice you are urinating more frequently than usual.

Are There Any Risks For Taking Lithium For Long Periods Of Time?

Hypothyroidism (low levels of thyroid hormone) may occur with long-term lithium use.

Rare kidney problems have been associated with long-term use of lithium. The risk increases with high levels of lithium. Your doctor will monitor your kidney function at routine check-ups to ensure this does not occur.

What Other Medications May Interact With Lithium?

The following medications can increase the levels and effects of lithium:

  • Diuretics, such as: hydrochlorothiazide (Microzide®), furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®), acetazolamide (Diamox®), chlorthiazide (Diuril®), and chlorthalidone (Thalitone®)
  • Non-steroidal anti-inflammatory medications (NSAIDs) including: Ibuprofen (Advil®, Motrin®), naproxen (Naprosyn®), celecoxib (Celebrex®), diclofenac (Voltaren®), and nabumetone (Relafen®)
  • Certain blood pressure medications, called angiotensin receptor blockers or angiotensin converting enzyme inhibitors.
    • Angiotensin receptor blockers (ARBs): valsartan (Diovan®), olmesartan (Benicar®), candesartan (Atacand®), losartan (Cozaar®)
    • Angiotensin converting enzyme (ACE) inhibitors: enalapril (Vasotec®), captopril (Capoten®), benazepril (Lotensin®), fosinopril (Monopril®)
  • Certain antidepressants, known as monoamine oxidase inhibitors (MAOIs). Examples include phenelzine (Nardil®), tranylcypromine (Parnate®), selegiline (Eldepryl®, Emsam®), and isocarboxazid (Marplan®)

The following medications may decrease the levels and effect of lithium:

  • Caffeine
  • Sodium chloride (table salt)
  • A medication used to treat breathing problems called theophylline (Theo–Dur®, Slo–Bid®)

How Long Does It Take For Lithium To Work?

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking lithium. It will probably take several weeks to see big enough changes in your symptoms to decide if lithium is the right medication for you.

Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.

Summary of Black Box Warnings

Lithium toxicity

Lithium toxicity is closely related to lithium blood levels and can occur at doses close to therapeutic levels; lithium levels should be monitored closely when starting the medication or if individuals experience side effects of the medication.

 

Provided by

(September 2021)

©2021 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

23 roles of lithium in the human body. Scientific data.

Lithium is an alkali metal found naturally in trace amounts in minerals, water, soil, and fruits, vegetables, and other plants grown in lithium-enriched soils (https://www.ncbi.nlm.nih.gov/pubmed /11601880).
Lithium is essential for the proper functioning of a number of enzymes, hormones, vitamins, growth factors and the immune and nervous systems (https://www. igsli.org/general-information-on-lithium/biochemical-effects-of-lithium.html). nine0003 In addition to lithium's role in treating psychiatric patients, this mineral has many health benefits, and the list continues to grow.

1. Lithium has a neuroprotective effect (protection of brain cells)

Long-term lithium treatment reduces glutamate-induced toxicity mediated by N-methyl-D-aspartate (NMDA) receptors. This effect was at least partially explained by the ability of lithium to suppress calcium influx, which affects the activity of the NMDA receptor. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39)
Thus, lithium has the potential to be beneficial for conditions such as mood disorders, Alzheimer's, diabetes, cancer, and inflammatory and autoimmune diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/# R39).

2. Lithium inhibits apoptosis

Lithium increases levels of heat shock proteins (HSPs), which promote proper 3D folding of proteins, refolding of damaged proteins, and utilization of atypical proteins (https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).
Among heat shock proteins, HSP70 has a wide range of neuroprotective effects against apoptosis. These effects are caused by GSK-3 inhibition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39). Lithium is also known to inhibit GSK-3 (https://www.ncbi.nlm.nih.gov/pubmed/8994831).
Long-term lithium treatment has been noted to induce the production of Bcl-2, a protein in the frontal lobe of the brain that protects cells from apoptosis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).

3. Lithium increases levels of neurotrophic factors BDNF, NGF and GDNF

Prolonged exposure of neurons to lithium in culture induces BDNF activity. (reference 2)
BDNF is one of the main neurotrophic agents indispensable for cognitive development, synaptic plasticity and neuronal survival, which also has antidepressant and calming effects. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39)
This probably occurs as a result of GSK-3 inhibition. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39)
Lithium also increases nerve growth factor (NGF) and glial neurotrophic factor (GDNF) levels in the hippocampus, frontal cortex, occipital region, and striatum (https://www.ncbi.nlm.nih.gov/pubmed/12974988). NGF and GDNF help increase neuronal survival and plasticity (the ability to regenerate and form new connections) among dopaminergic, cholinergic, and serotonergic neurons in the central nervous system. nine0005

4. Lithium promotes the regeneration of cerebral and cardiac vessels (VEGF)

Lithium leads to an increase in the production of vascular endothelial growth factor, VEGF, which promotes cell growth and regeneration of blood vessels after a stroke (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).
By increasing VEGF levels, lithium may promote faster recovery after a stroke or heart attack (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).
The likely mechanism is lithium inhibition of GSK-3 (https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).

5. Lithium induces autophagy

Autophagy or "cell self-destruction" is when cells break down and recycle cellular components to reuse raw materials (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39). Autophagy is thought to slow down aging, prevent cancer, and is important for neuronal function and survival (http://genesdev.cshlp.org/content/21/22/2861.full, https://www.ncbi.nlm.nih .gov/pmc/articles/PMC2020444/). nine0003 Lithium can induce autophagy by depleting inositol stores independently of mTOR inhibition (which by itself usually induces autophagy) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).
Since lithium induces autophagy, the drug may be especially useful for patients with neurodegenerative diseases - Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis and Huntington's disease, since such disorders are characterized in part by the accumulation of misfolded proteins (https://www. ncbi.nlm .nih.gov/pmc/articles/PMC3172812/#R39).

6. Lithium increases neurogenesis and improves cognitive function

Lithium has been found to stimulate progenitor and stem cells in a culture of brain hippocampal neurons (neurons from the memory center). In addition, lithium prevents loss of proliferation caused by glutamate or cortisol (glucocorticoids). Also, long-term lithium treatment promotes the conversion of these precursor cells into neurons (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39).
In addition, long-term lithium treatment not only improves neurogenesis in the hippocampus (memory center) in healthy mice, but also restores neurogenesis in the brain of an animal model of Down syndrome (https://www.ncbi.nlm.nih.gov/pmc/articles /PMC3172812/#R39).
The drug also enhances neurogenesis (the formation of new neurons) in the subventricular zone, the only area besides the hippocampus (memory center) where such an effect was observed, which caused a persistent increase in gray matter volume in patients (https://www. ncbi.nlm.nih. gov/pmc/articles/PMC3172812/#R39).
Lithium increases N-acetyl aspartate (NAA) levels (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(00)00252-3/abstract), which can be seen as an indicator of creativity and correlates with IQ scores (https http://www.ncbi.nlm.nih.gov/pubmed/21983183). One possible consequence of this may be more efficient communication between the two hemispheres of the brain, resulting in improved brain activity. (https://www.ncbi.nlm.nih.gov/pubmed/21983183)
Long-term lithium treatment increases long-term potentiation (LTP) in hippocampal neurons, which makes nerve cells more efficient and thus aids in learning and memory (http://europepmc.org/abstract/MED/17996377).

7. Lithium can calm and stabilize mood

In animals, lithium staunchly reduces search activity and aggression. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150568/)
In humans, lithium is also known to have a calming and mood-stabilizing effect, and is also used to treat depression, bipolar disorder, and schizophrenia (https://en. wikipedia.org/wiki/Lithium_(medication).
Lithium carbonate is the standard of care for bipolar affective disorder (BAD), reducing the frequency of manic episodes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560740/pdf/10885180.pdf, https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3181868/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876031/). nine0003 Lithium has also been shown to be effective in reducing aggressive behavior in people with attention deficit hyperactivity disorder (ADHD) (https://www.ncbi.nlm.nih.gov/pubmed/12154153).
Increased levels of naturally occurring lithium in drinking water may reduce suicide rates (https://en.wikipedia.org/wiki/Lithium_(medication)). This may be partly due to the fact that lithium increases the synthesis and release of serotonin (it also reduces the level of norepinephrine) (https://en.wikipedia.org/wiki/Lithium_(medication)). nine0003 Lithium increases CCK levels in the brain and this is part of the mechanism by which lithium prevents mania in bipolar disorder.

8. Lithium fights depression

Lithium administration is one of the most studied approaches in the treatment of depression refractory to standard therapy (https://www.ncbi.nlm.nih.gov/pubmed/22796912).
Lithium increases postsynaptic sensitivity to serotonin via the 5-HT1A receptor, which partly explains its antidepressant activity. (http://onlinelibrary.wiley.com/doi/10.1002/syn.8

302/abstract?systemMessage=Wiley+Online+Library....)
Lithium also increases BDNF levels, which helps with depression.
Lithium partially alleviates depression in animals by increasing the number of neural stem cells.

9. Lithium has potential use in the treatment of Huntington's disease

Lithium prevents nerve cell death in animal models of Huntington's disease (https://www.ncbi.nlm.nih.gov/pubmed/11591460, https://www.ncbi.nlm.nih.gov/pubmed/14702090).
Lithium reduces excess NMDA receptor function, and thus may potentially counteract the increased NMDA receptor activation that occurs in the brains of patients with Huntington's disease (https://www. ncbi.nlm.nih.gov/pubmed/21492946).
Research into patients with Huntington's disease is ongoing.

10. Lithium reduces insulin resistance

Lithium improves insulin-stimulated glucose transport and glycogen synthesis in insulin-resistant rat muscle rat muscle (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC26339thirty/). These effects depend on p38 MAPK (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633930/).
Lithium reduces insulin release (https://www.ncbi.nlm.nih.gov/pubmed/369819).
The use of lithium significantly increased glucose transport into muscle cells by 2.5 times in response to insulin administration and also increased insulin sensitivity (https://www.ncbi.nlm.nih.gov/pubmed/8013755).

11. Lithium has a positive effect on autoimmune diseases and reduces inflammation

Lithium has shown strong immune system activation effects (https://www.ncbi. nlm.nih.gov/pubmed/15236914/, https://www.ncbi.nlm.nih.gov/pubmed/12208183).
Lithium, by inhibiting GSK-3, has been noted to have a beneficial effect in animal models of autoimmune disease. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532311/)
Lithium inhibits the activity of Th2 cells and interferon-gamma (but not Th27 cells). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532311/)
Lithium has anti-inflammatory effects by decreasing the production of IL-1β and TNF-α, and increasing the production of IL-2, TGF, IL-1RA and IL-10 (http://www.if-pan.krakow.pl/pjp/pdf/ 2003/3_353.pdf, https://www.ncbi.nlm.nih.gov/pubmed/10367558).
However, studies have also shown that, under certain experimental conditions, lithium also has pro-inflammatory effects by increasing the production of IL-4, IL-6 and TNF-α (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063502 /).
Lithium increases IgG and IgM antibody levels (https://www.sciencedirect.com/science/article/pii/009825).
Lithium reduces the production and activity of prostaglandins, thus preventing their negative effect on the immune system (https://www.sciencedirect.com/science/article/pii/0006295274

9).
Lithium reduces the frequency and duration of recurrent infections of labial and genital herpes, and also reduces the frequency of colds (https://www.ncbi.nlm.nih.gov/pubmed/2155671, https://jhu.pure.elsevier.com/ en/publications/suppression-of-recurrent-genital-herpes-infections-wit...). nine0005

12. Lithium has a positive effect on bone tissue

A comparative study was conducted to assess the bone density of the hip and lumbar spine in 75 volunteers who received lithium and 75 healthy volunteers who did not receive lithium; groups were normalized for age, sex, and body mass index. The study found lower rates of bone remodeling in volunteers who received lithium. Mean bone mineral density in lithium-treated volunteers was 4.5% higher at the spine, 5. 3% higher at the femoral neck, and 7.5% higher at the trochanter of the femur (https://www.ncbi .nlm.nih.gov/pubmed/18992857).
Lithium use is associated with a reduced risk of bone fractures and increased osteogenesis , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297659/).

13. Lithium can be helpful in restoring our circadian rhythm

As you know, lithium is the standard of care for the treatment of patients suffering from bipolar disorder, which is characterized by the presence of episodes of mania and depression. nine0003 One mechanism by which lithium may help with bipolar disorder is by lengthening the circadian rhythm. People with bipolar disorder tend to have a shorter circadian rhythm compared to 24 hours.
Lithium promotes a faster recovery of our circadian rhythm in response to light and darkness (http://geum.ru/next/art-91286.php).

14. Lithium improves mitochondrial function

Lithium increased the lifespan of roundworms (nematodes) and improved overall health outcomes, including mitochondrial energy production (https://www. ncbi.nlm.nih.gov/pubmed/24398558).
Lithium may improve mitochondrial function by increasing the rate of replacement of broken mitochondria (https://www.ncbi.nlm.nih.gov/pubmed/24398558).
Lithium also inhibits mir-34a, which in turn inhibits NAMPT, an enzyme involved in the formation of NAD+ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172812/#R39, https://en .wikipedia.org/wiki/Nicotinamide_phosphoribosyltransferase). Therefore, lithium likely increases free NAD+ levels.

15. Low doses of lithium increase life expectancy

The researchers found a positive correlation between life expectancy and lithium levels in drinking water. There has been a decrease in the risk of death from all diseases in areas of Japan with higher lithium levels.
Similar was noted in the situation with roundworms (nematodes). Long-term low-dose lithium exposure can delay aging and clearly reduce mortality in evolutionarily distinct species (https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3151375/). The improvement in health status was accompanied by improved mitochondrial function. (https://www.ncbi.nlm.nih.gov/pubmed/24398558)

16. Lithium may improve symptoms of Tourette's syndrome

Tourette's syndrome is a neurological disorder characterized by involuntary muscle movements and uncontrolled vocal sounds (https://www.nhs.uk/conditions/tourettes-syndrome/).
In a small study of 3 patients, lithium resulted in a better outcome than haloperidol, a common drug prescribed for Tourette's syndrome. In patients who took lithium, there was a significant decrease in the number of tics and involuntary speech sounds. Patients had no side effects and were symptom-free for several months (https://www.ncbi.nlm.nih.gov/pubmed/270894).

17. Lithium may be useful in cases of tardive dyskinesia

Tardive dyskinesia is a neurological disorder characterized by sudden, involuntary, jerky movements of the face and/or body that occur with long-term use of psychotropic drugs (https://www. ninds.nih.gov/Disorders/All-Disorders/Tardive-Dyskinesia- Information-Page).
Studies have shown that lithium significantly reduced the severity of tardive dyskinesia (https://www.sciencedirect.com/science/article/pii/S0924977X07001496, https://www.ncbi.nlm.nih.gov/pubmed/788002, https://www.ncbi.nlm.nih.gov/pubmed/804260).
Lithium reduced arousal and aggression, and reduced involuntary movements (https://www.ncbi.nlm.nih.gov/pubmed/788002, https://www.ncbi.nlm.nih.gov/pubmed/804260).
However, two large studies found no consistent effects of lithium on tardive dyskinesia (https://www.ncbi.nlm.nih.gov/pubmed/790411, https://www.karger.com/Article/Abstract/117629).

18. Lithium helps to cope with obsessive-compulsive behavior

Obsessive-compulsive disorder (OCD), or obsessive-compulsive disorder, is a mental disorder characterized by obsessive thoughts and behavior (https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index. shtml).
The addition of lithium to the diet results in a reduction in OCD symptoms resistant to standard therapy (https://www.ncbi.nlm.nih.gov/pubmed/6435460). nine0003 Compulsive and pathological gamblers have also shown a good response to dietary lithium supplementation, which may regulate dopamine imbalance in the brain (https://www.ncbi.nlm.nih.gov/pubmed/20588072).

19. Lithium can relieve headaches

Lithium can reduce the severity of both chronic and episodic cluster headache (http://scielo.isciii.es/scielo.php?pid=S0213-616320000006&script=sci_arttext). nine0003 Lithium carbonate taken before bed helped eliminate "hypnic headache" (headache that older people suffer from waking up at the same time at night) (https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1891726/, http://pn.bmj.com/content/practneurol/5/3/144.full.pdf).

20. Lithium may be effective in treating anorexia nervosa

Patients suffering from anorexia nervosa for many years have been successfully treated with lithium carbonate (https://www. ncbi.nlm.nih.gov/pubmed/842388, https://www.ncbi.nlm.nih.gov/pubmed /6801096).
One patient gained 12 kg and the other 9 kg within 6 weeks, and the weight gain on lithium therapy was maintained for a year (https://www.ncbi.nlm.nih.gov/pubmed/842388).
However, further studies of lithium are required to evaluate its utility in the treatment of anorexia nervosa.

21. Lithium may be effective in treating alcoholism

Lithium orotate is used to treat alcoholism.
The drug has been shown to be safe, with minimal side effects such as muscle weakness, loss of appetite, or mild lethargy (https://www.ncbi.nlm.nih.gov/pubmed/3718672). nine0003 Lithium carbonate promotes alcohol abstinence, reduces subjective withdrawal symptoms, and delays time to first alcohol consumption (https://jamanetwork.com/journals/jamapsychiatry/article-abstract/494005, https://www.ncbi.nlm.nih.gov /pubmed/181193).
Patients treated with lithium were less likely to be rehospitalized for alcohol rehabilitation during 18 months of follow-up (https://www. ncbi.nlm.nih.gov/pubmed/2494686).

22. Lithium may reduce seizure frequency

Data on the effect of lithium on seizure frequency is still controversial (https://www.ncbi.nlm.nih.gov/pubmed/3379144).
Some patients with epilepsy show a statistically significant reduction in seizure frequency as well as behavioral improvement with lithium treatment (https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490891).
Lithium can be used to control treatment-resistant temporal lobe epilepsy.
However, some patients with epilepsy have experienced an increase in the number of seizures during lithium treatment (https://www.healio.com/psychiatry/journals/psycann/2013-6-43-6/%7B0346b54f-2ca1-4215-8d9e-10708601ad..., http://www.academia.edu/6195616/Non-convulsive_status_epilepticus_during_lithium_treatment_at_therap..., https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.11.3.414).

23. Lithium may relieve symptoms of Meniere's disease

Meniere's disease is an ear disease that causes severe dizziness, tinnitus, hearing loss, and a feeling of fullness in the ear (https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-causes/syc-20374910).
In 70% of patients with Ménière's disease, a decrease in the frequency and severity of seizures was observed during lithium treatment (http://www.tandfonline.com/doi/abs/10.3109/00016487409126326?journalCode=ioto20&).
However, in a study involving patients who received lithium and placebo for 6 months, there was no difference between the two groups (https://www.ncbi.nlm.nih.gov/pubmed/790893).

Additional information

• Lithium reduces brain levels of inositol (https://www.nature.com/articles/newbio233267a0). nine0003 • Lithium increases vasopressin, which stimulates ACTH and cortisol (http://journals.plos.org/plosone/article?id=10. 1371/journal.pone.0027613).

Genetic factors that influence lithium sensitivity

Serotonin transporter 5-HTTLPR (SLC6A4)
Patients with 2 copies of the short form of this gene respond less well to lithium treatment than patients with the long form of the gene (https://www.nature.com/articles/6500006). nine0003 Corresponding allele: The presence of rs25531 may indicate the long form of the gene.

GSK3beta -50T/C
These mutations are responsible for the variability in responses to lithium in patients with bipolar disorder, although the results are not uniform (https://www.ncbi.nlm.nih.gov/pubmed/14729229, https://www.ncbi.nlm. nih.gov/pubmed/15694273, https://www.ncbi.nlm.nih.gov/pubmed/16861141)
The C allele is associated with a more improved response to lithium supplemented antidepressants (https://www.ncbi.nlm.nih.gov/pubmed/17628506). nine0005

Lithium in the blood

Lithium is one of the most well studied and commonly used drugs for the treatment of patients suffering from bipolar disorders.

Synonyms English

Lithium.

Test method

Atomic absorption spectrometry (AAS).

Units

µg/L (micrograms per liter), mmol/L (millimoles per liter).

Which biomaterial can be used for research? nine0235

Venous blood.

How to properly prepare for the examination?

  • Do not eat for 2-3 hours before the test, you can drink pure non-carbonated water.
  • Do not smoke 30 minutes prior to the study.

Overview of the study

Lithium preparations are among the most well studied and widely used in the treatment of bipolar disorder, a mental illness characterized by alternating periods of depression and mania. These periods can last from several days to several months or even years. The patient's condition ranges from apathy to euphoria. Both adults and children are susceptible to bipolar disorder. nine0005

Lithium is often referred to as a "mood stabilizer" and is commonly prescribed for patients not responding to other medications. It is a relatively slow-acting drug, sometimes it can take several months before it stabilizes the mental state.

The amount of the drug must be sufficient to create a stable concentration of lithium in the blood, necessary for a therapeutic effect. This dosage for each patient is individual and depends on age, general health and other medications. nine0005

Lithium levels should be checked regularly: if it is too low, treatment will not be effective, and if it is too high, it can cause poisoning with nausea, vomiting, diarrhoea, confusion and trembling. Very high concentrations of lithium can lead to stupor, heart attacks, and even death.

What is research used for?

  • To control whether the lithium level is sufficient for treatment.
  • To determine the required level of lithium in the blood at the beginning of medication. nine0263
  • To monitor fluctuating lithium levels.
  • To find out how a patient's medications affect lithium levels.
  • If lithium toxicity is suspected.

When is the test scheduled?

  • At the beginning of treatment with drugs containing lithium, or when they are taken again after a break.
  • Regularly after reaching a sufficient level of lithium in the blood for treatment - to confirm that the required level is maintained. nine0263
  • When it is necessary to find out the reason for the failure of lithium therapy (whether the amount taken is too low, or the fact is that, for example, the patient does not comply with the prescription for taking lithium).
  • For symptoms suggestive of a toxic effect (drowsiness, weakness, incoordination, slurred speech, nausea, vomiting and diarrhea, confusion, trembling).

What do the results mean?

Reference values ​​

Concentration: 0. 7 - 84 µg/l.

Therapeutic concentration: 0.6 - 1.2 mmol/l.

If the lithium level is within the normal range, then the drug has a therapeutic effect without a toxic effect.

If the concentration of lithium in the blood is low, then most likely the patient does not receive the right amount of medication, if it is higher and there is a side effect - the dose taken is too high. However, you should not reduce the amount of the drug or stop taking it without consulting a doctor, as this may complicate the disease. Treatment should be prescribed by a doctor: for each person, taking into account individual characteristics, he will select the dose that has the most favorable therapeutic effect. nine0005

What can influence the result?

Theophylline and caffeine lower lithium levels.

Important Notes