Lithium
- Kevin Keane
- Aug 13, 2024
- 4 min read
Lithium has many amazing benefits, but it comes with unique side effects and dosing. Please read all of the following to learn more about it and see if it's a good fit for you:
Lithium, a medication often prescribed for bipolar disorder, has many impressive benefits:
1. Bipolar Disorder Treatment: Lithium is effective in managing both depressive and manic phases of bipolar disorder. It's shown to be particularly effective in long-term treatment, maintaining mood stability and preventing recurrence of mood episodes.
2. Unipolar Depression: Lithium can improve the effects of antidepressants and prevent recurrent episodes of severe depression. It's especially recommended for patients with severe depression and high suicidal risk. Studies show that lithium treatment can reduce the rate of rehospitalizations for depression.
3. Suicide Prevention: Lithium is shown to have anti-suicidal effects. Higher concentrations of lithium in drinking water have been associated with lower suicide rates.
4. Dementia Risk Reduction: Lithium use is linked with a lower incidence of dementia in old age. Patients on lithium have shown better visual memory and slower rates of cognitive decline, even in cases of mild cognitive impairment and Alzheimer's dementia.
5. Neuroprotective Effects: Lithium can increase brain volume, promote nerve cell growth, and decrease cell death. It has shown potential in reducing the severity of brain lesions associated with various neurodegenerative disorders.
6. Telomere Lengthening: Lithium can increase the length of telomeres (protective caps at the end of our chromosomes), which is important for maintaining both physical and mental health. Longer telomere length is associated with healthier lifestyle choices and positive mental state.
7. Reducing Medical Illness Incidence: Lithium can lower the incidence of certain neurological disorders, heart attack, and some types of cancer. It may also contribute to increased lifespan.
8. Enhancing Drug Efficacy: When combined with other medications, lithium can enhance their effectiveness in treating bipolar disorder.
9. Prolonging Life: Lithium has been shown to prolong life in patients with bipolar by many years, due to many of the benefits listed above.
10. Antiviral: there is evidence that patients on lithium have fewer viral infections and the viral infections they do encounter are less intense. This is at least partly due to Lithium’s effect on increasing neutrophils (a subtype of white blood cell).
11. Lowering the Risk of Strokes: there is growing evidence that lithium can lower the risk of strokes.
How Lithium Works
1. Lithium inhibits the enzymatic degradation of inositol phosphates to free intracellular inositol, leading to decreased signal transduction & neurotransmission.
2. It may attenuate or reverse impairments in neuronal plasticity, neurogenesis, or cell survival.
3. Lithium directly inhibits glutamatergic activity and increases serotonin levels.
Lithium Dose for MDD Treatment:
Aim for a dose to a level of 0.4-0.6. Higher doses carry an increased risk for nephropathy. It's recommended to take the entire dose at night for renal protection.
Lithium and Children:
Lithium is FDA approved for the treatment of manic episodes in patients over the age of 12.
Lithium's Efficacy:
According to a large meta-analysis, lithium monotherapy did better than all atypicals and anticonvulsants at preventing rehospitalization and maintaining euthymia in most large trials. In some cases, combinations like Lithium + Olanzapine or Lithium + Seroquel were superior to lithium monotherapy.
Factors in favor of Responding to Lithium:
1. Non rapid cycling (less than 4 episodes per year)
2. Textbook euphoria in manic phase
3. No psychotic symptoms
4. Positive family history
5. High adherence to treatment
6. Later age of onset of first manic episode
7. Less than 3 prior manic episodes
8. Mania is the presenting issue
Less Common Issues to Watch for With Lithium:
1. Thyroid Issues: Lithium can lower thyroid hormone levels and cause hypothyroidism in some people, which can be corrected with thyroid hormone supplementation.
2. Muscle Stiffness and Arrhythmias: These are more common in older people, and those with pre-existing arrhythmias should use lithium with caution.
3. Kidney Function: Long-term lithium use can affect kidney function, but careful monitoring and adjustments to dosage can help manage this.
4. Other Side Effects: Lithium can cause various side effects such as tremors, skin lesions, and increases in serum calcium. These can often be treated with dose adjustments or other medications.
5. Pseudotumor Cerebri: (increased intracranial pressure) especially in obese females.
Using Lower Dose Lithium in Bipolar Disorder:
Evidence does not support the use of lower dose lithium in bipolar disorder. Aim for 0.8 during symptomatic phases and 0.5-0.8 if asymptomatic for a few months. However, there is evidence to support a reduction in suicidal thinking in sub-therapeutic dosing (ie - 300mg)
Dosing Lithium to Minimize Side Effects:
The entire dose of Lithium should be given once a day at bedtime. Benefits of once-a-day dosing include less polyuria, less kidney damage, and increased adherence. This means that we usually start with Lithium ER (extended release).
Lithium and Antihypertensives:
Certain antihypertensives, like ACE inhibitors and thiazides, can increase lithium levels, while osmotic diuretics can decrease lithium levels. It's okay to use lithium with loop diuretics, beta-blockers, and amiloride.
Lithium Levels
Lithium level should be drawn 8-12 hours after the last dose, and at least 5 days out from the dose change.
Lithium and PTH
Lithium can increase PTH, which can lead to increased calcium. In some cases, resection may be needed.
Lithium Use in Pregnancy
Each case should be considered individually. Doses at 600mg or lower have not shown increased risk of cardiac malformation.
Tapering Lithium with Worsening Kidney Function
There's no specific guideline, but if there's stage 3 or greater renal impairment, or the renal impairment is worsening, tapering off the lithium might be unavoidable
***do not take with ibuprofen ; keep fluid intake up!
Written by:
Joesph Gagnon Jr.