Bipolar Disorder: Lithium for Bipolar Disorder

Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression.

Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy.

Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior.

It usually takes one to two weeks for lithium to begin working. Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney function. Lithium works best if the amount of the drug in your body is kept at a constant level. Your doctor will also probably suggest you drink eight to12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it's important to consume a steady amount every day.

The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.

Lithium Side Effects

About 75% of people who take lithium have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects can be relieved by tweaking the dose of lithium. However, never change your dose or drug schedule on your own. Do not the change brand of this medication without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.

Common side effects can include:

• Hand tremor (If tremors are particularly bothersome, an additional medication can help.)
• Increased thirst
• Increased urination
• Diarrhea
• Vomiting
• Weight gain
• Impaired memory
• Poor concentration
• Drowsiness
• Muscle weakness
• Hair loss
• Acne
• Decreased thyroid function (which can be treated with thyroid hormone)

Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate.

Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.

If you miss a dose, take it as soon as you remember it -- unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not "double up" the dose to catch up.

There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn't recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.

Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.