Bipolar disorder is a serious mental illness that affects more than 40 million people worldwide, including about 2.8% of the U.S. adult population annually, according to the National Institute of Mental Health (NIMH).[1] One of the oldest and most well-established treatments for bipolar disorder is lithium, a naturally occurring element that plays a crucial role in stabilizing mood. Despite the rise of newer medications, lithium remains a gold standard for treating various forms of bipolar disorder, especially acute mania and maintenance treatment.

In this article, we’ll explore how lithium works, its effectiveness, side effects, necessary monitoring, and its place in modern psychiatric care. We’ll also explain key terms like lithium toxicity, serum lithium levels, and lithium dosage to help patients and caregivers understand what to expect from this long-standing treatment option.

What Is Lithium and How Does It Work?

Lithium salts, such as lithium carbonate and lithium citrate, are prescribed to treat bipolar disorder and other mood disorders. Lithium acts on the central nervous system (CNS), affecting how nerve cells communicate. Although the exact molecular mechanisms are still not fully understood, it is believed that lithium modulates neurotransmitter activity, reduces abnormal brain signaling, and stabilizes mood fluctuations.[2]

Used as a mood stabilizer, lithium is effective in:

Importantly, lithium monotherapy (lithium used alone without other drugs) is often effective for many individuals with manic depressive illness.

Who Benefits from Lithium Treatment?

Lithium is primarily used to treat bipolar disorder, particularly bipolar I disorder, where patients experience intense manic episodes. It is also prescribed as maintenance therapy to prevent future depressive episodes or mania in bipolar patients.

Recent systematic reviews show that lithium is more effective than other mood stabilizers in preventing hospitalization and relapse, especially in the long-term treatment of bipolar disorder.[3] In cases of acute bipolar depression, lithium can be used alone or as adjunctive lithium therapy alongside antidepressants.

It is sometimes also used for refractory depression, major depressive disorder, and affective disorders when standard treatments fail.

Dosage, Forms, and Administration

Lithium treatment is typically started at a low lithium dose and adjusted based on individual treatment response and serum lithium levels. Lithium comes in:

The goal is to reach target serum concentrations between 0.6 and 1.2 mEq/L for acute treatment and between 0.6 and 0.8 mEq/L for maintenance treatment. Too much lithium in the bloodstream can lead to lithium toxicity, while levels that are too low may not be effective.

Patients often begin noticing improvements in manic symptoms within 1 to 3 weeks of taking lithium, although full stabilization may take longer.

Monitoring and Regular Blood Tests

Because the therapeutic range for lithium is narrow, regular blood tests are essential to monitor serum concentrations, kidney function, and thyroid health. Testing is usually done:

Maintaining proper lithium levels is crucial. Fluctuations can result from a low salt diet, dehydration, or changes in kidney function. The kidneys excrete lithium, and any impairment in lithium excretion can raise serum levels dangerously.

Side Effects and Lithium Toxicity

Most lithium-treated patients tolerate the medication well, but side effects can occur, especially at higher lithium concentrations or in the case of lithium poisoning. Common side effects include:[4]

Lithium Toxicity

Lithium toxicity can be acute (from overdose) or chronic (due to gradual accumulation). Signs of toxicity include:[4]

Patients should seek immediate medical attention if symptoms of lithium intoxication appear. Serum lithium levels above 1.5 mEq/L are considered toxic, and levels above 2.0 mEq/L are a medical emergency.

Lithium and Kidney Health

Long-term use of lithium can affect the kidneys’ ability to concentrate urine, increasing the risk of chronic kidney disease (CKD). While only a minority of patients develop serious kidney issues, it’s critical to monitor kidney function regularly.

Signs of kidney impairment may include:

Discontinuing lithium may be considered if chronic toxicity develops or kidney function declines significantly, but such decisions must be made with a psychiatrist and nephrologist.

Factors That Affect Lithium Levels

Several factors can affect lithium dosage and blood levels, including:

Because lithium is sensitive to fluid and electrolyte balance, patients are advised to maintain consistent salt and fluid intake.

Lithium and Mental Health Outcomes

Beyond mood stabilization, lithium may have neuroprotective effects and is the only mood stabilizer shown to reduce suicide risk in psychiatric disorders. According to a 2022 systematic review in The Lancet Psychiatry, lithium reduced suicide rates by over 60% in bipolar disorder and major depression compared to placebo.[5]

Furthermore, lithium is associated with a decreased risk of dementia and has shown promise in improving treatment-resistant affective episodes.

Is Lithium Right for You?

While lithium is not suitable for everyone, it remains a cornerstone in the treatment of bipolar disorder and other mood disorders. Its benefits are particularly evident in:

Patients who adhere to long-term treatment plans and undergo regular blood tests can experience substantial improvement in quality of life and functioning.

However, lithium is generally avoided in:

Get Connected to Bipolar Disorder Treatment

Lithium for bipolar disorder remains a time-tested, evidence-based treatment that can offer life-changing stability for many individuals. Its success, however, depends on regular monitoring, awareness of potential side effects, and a strong partnership between patient and healthcare provider.

If you or someone you know is considering taking lithium to treat mental illness, contact 1st Step Behavioral Health. We can help you evaluate whether it’s the right choice. Proper education and medical supervision are key to maximizing the effects of lithium while minimizing risks.

Frequently Asked Questions (FAQ)

1. Can I drink alcohol while taking lithium?

While occasional, moderate alcohol use may not interfere directly with lithium, it’s generally discouraged. Alcohol can affect mood stability, dehydration, and kidney function — all of which can influence serum lithium levels. Heavy or frequent drinking increases the risk of lithium toxicity and impairs treatment effectiveness. Always consult your doctor before consuming alcohol while on lithium therapy.

2. What should I do if I miss a dose of lithium?

If you miss a dose, take it as soon as you remember — unless it’s close to the time for your next scheduled dose. Do not double up or take extra lithium to “catch up.” Missing doses can destabilize lithium levels and potentially lead to mood relapse or side effects. Consistency is key in lithium treatment.

3. Can lithium be used during pregnancy or breastfeeding?

Lithium use during pregnancy, especially the first trimester, carries some risk of birth defects (e.g., Ebstein’s anomaly, a rare heart defect). However, stopping lithium abruptly can lead to severe relapse of bipolar disorder, which also carries risks for both mother and baby. Decisions must be individualized and closely monitored by a psychiatrist and obstetrician. Lithium does pass into breast milk, so breastfeeding while taking lithium is generally not recommended without specialist oversight.

4. How does lithium compare to newer mood stabilizers or antipsychotics?

While other mood stabilizers like valproate, lamotrigine, or second-generation antipsychotics are often prescribed, lithium remains unique in its anti-suicidal properties and long-term relapse prevention. Some newer drugs may have fewer side effects or require less monitoring, but lithium may be more effective for classic bipolar I disorder or individuals with a strong family history of the illness. The choice often depends on individual response, tolerance, and health considerations.

5. Is it possible to stop lithium once I feel better?

Feeling better is often a result of effective treatment, not a sign that the illness has resolved. Stopping lithium suddenly can lead to rebound manic or depressive episodes and increase the risk of hospitalization or suicide. If discontinuation is necessary (due to side effects or medical reasons), it should be done gradually and under close medical supervision.

6. Are there any dietary restrictions while on lithium?

Yes. It’s important to maintain a consistent salt intake because lithium excretion by the kidneys is closely tied to sodium balance. A sudden shift to a low salt diet can raise lithium concentrations, increasing toxicity risk. Staying hydrated is also essential, especially during hot weather or exercise. Avoid sudden dietary changes without consulting your doctor.

References:

  1. The National Institute on Mental Health (NIMH): Bipolar Disorder 
  2. The National Library of Medicine (NLM): Lithium 
  3. American Academy of Child and Adult Psychiatry: Lithium Versus Other Mood-Stabilizing Medications in a Longitudinal Study of Youth Diagnosed With Bipolar Disorder
  4. Medline Plus: Lithium
  5. The National Library of Medicine (NLM): Lithium Suicide Prevention: A Brief Review and Reminder
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