Rarely, lithium is reported to cause irreversible, permanent neurological sequelae such as cerebellar impairment, dementia, parkinsonian syndromes, choreoathetosis, brain stem syndromes, and peripheral neuropathies.
Prolonged lithium intoxication >2 mM can cause permanent brain damage. Lithium has low mutagenic and carcinogenic risk. Lithium is still the most effective therapy for depression. It "cures" a third of the patients with manic depression, improves the lives of about a third, and is ineffective in about a third.
Adverse effects of long-term lithium treatment
Some clinicians believe that lithium may cause impaired cognition. A meta-analysis of bipolar patients treated with lithium and patients treated with other medications showed that lithium had a moderately unfavorable effect on cognitive function.
Most often, lithium neurotoxicity is reversible but sometimes may be irreversible. Reversible lithium neurotoxicity has been defined as cases of lithium neurotoxicity in which patients recovered without any permanent neurologic sequelae, even after 2 months of an episode of lithium toxicity.
Lithium has a negative effect on memory, as concluded from a relatively small number of well designed and controlled studies that showed an improvement of memory functions after temporary discontinuation of lithium.
A common complaint made by those who take lithium, but one which may easily be overlooked, is cognitive compromise. Clinically, patients describe this as “brain fog”-an elusive admixture of complaints regarding attention, concentration, and memory occurring in conjunction with a slowing of thought processes.
In those exposed to lithium, 9.7% of patients were also subsequently diagnosed with dementia. In those that weren't exposed to lithium, 11.2% of people went on to develop dementia.
In early lithium toxicity, you may have mild confusion. As the toxicity worsens, you may feel delirious or even have seizures or go into a coma. In very rare cases, lithium toxicity may cause diabetes insipidus. This condition leads to large amounts of urine in your body, regardless of how much fluid you drink.
Interestingly, lithium appears to preserve or increase the volume of brain structures involved in emotional regulation such as the prefrontal cortex, hippocampus and amygdala, possibly reflecting its neuroprotective effects.
In addition to the well-known positive effects on mood,18 lithium has also been linked with longer overall longevity. Two studies have found that individuals living in areas with even modest, low levels of lithium in the drinking water tend to live longer.
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.
In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment.
Lithium has been associated with impaired memory, word finding difficulties, and impaired recall. Often, my patients have reported a cognitive "dulling" and a loss of cognitive "creativity" with lithium use that they found most disturbing. This does appear to be dose related.
Long-term lithium use may cause cortical atrophy and cognitive dysfunctions. Patients who use lithium should be monitored with brain MRI.
Bipolar illness is associated with neurocognitive deficits, even in the remitted state. Bipolar patients commonly complain of lithium-induced cognitive slowing, which may lead to nonadherence, even though limited and poorly controlled studies have shown that lithium has, at most, mild cognitive effects.
mood swings, anxiety and irritability, which may feel very similar to the symptoms of bipolar disorder. headaches. dizziness. stomach and gut problems.
The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake.
Results: Long-term lithium treatment is associated with a reduced urinary concentrating ability, with subsequent polyuria and polidypsia and nephrogenic diabetes insipidus (in 10-40% of patients).
The standard therapeutic range for serum lithium levels normally falls between 0.6 and 1.2 mEq/l . To diagnose toxicity in a person who normally takes lithium, doctors should take their serum levels 6 to 12 hours after their last dose.
Conclusion: Chronic maintenance treatment with lithium affects the peripheral nerves, even if the impairment rarely is such as to warrant discontinuation of treatment. Monitoring of ENG results could be useful for the early detection of neurotoxicity of lithium.
Calcium ions could be used as a greener, more efficient, and less expensive energy storage alternative to lithium-ions in batteries because of its abundance and low cost, according to a study.
Current alternatives to lithium for the prevention of relapse in affective disorder are antidepressants (especially in unipolar illnesses), carbamazepine and maintenance ECT. There are numerous other potential pharmacological agents, in particular val- proate and valpromide.
Quetiapine covers ground that lithium does not. It is more effective against mixed manias, while lithium is preferred for the purer, euphoric highs. It also works better in acute depressive episodes.