If you have bipolar disorder, you may be offered lithium for a longer period, to prevent or reduce your risk of relapse. Your doctor may suggest that you commit to taking lithium for at least six months, possibly longer. This is because it can take some time to make sure the medication is working effectively.
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.
With long-term use, lithium can cause chronic tubulo-interstitial nephritis, which is characterized by a decrease in the glomerular filtration rate (GFR) and may lead to chronic kidney disease (lithium nephropathy) (97, 98).
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.
Adverse effects were the most common cause for lithium discontinuation. Among the adverse effects, diarrhoea, tremor, creatinine increase, polyuria/polydipsia/diabetes insipidus and weight gain were the top five reasons for discontinuing lithium.
Discontinuing lithium may not cause typical withdrawal symptoms, but your bipolar disorder symptoms may return when you stop taking it. Lithium is a mood stabilizer often used to treat bipolar disorder.
The ones that treat bipolar depression are cariprazine (Vraylar), lurasidone (Latuda), olanzapine-fluoxetine combo (Symbyax), and quetiapine (Seroquel). Among them, lurasidone offers a good balance of efficacy and tolerability.
Lithium might increase a brain chemical called serotonin. Some medications also have this effect. Taking lithium along with these medications might increase serotonin too much. This might cause serious side effects including heart problems, seizures, and vomiting.
It does not seem to be addictive or even habit-forming. Lithium does not produce any of the classic withdrawal symptoms associated with substance use disorder, and it is inexpensive. Since lithium is a medication, it must be obtained with a prescription and according to a physician's instructions.
Background: Though often perceived as a “silver bullet” treatment for bipolar disorder (BD), lithium has seldom reported to lose its efficacy over the time.
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.
Typical dosing for lithium
The typical starting dose depends on what form of lithium you're prescribed. Lithium immediate-release tablets and capsules: Adults and children above 30 kg (66 lbs): The typical starting dose is 300 mg by mouth 3 times a day.
If you need to stop taking lithium, it is best for you to come off it gradually, over at least four weeks, but preferably over three to six months. Gradually reducing the dose will make it less likely that your symptoms come back (compared to stopping the lithium quickly).
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.
While there are different medications used to treat manic and depressive episodes in people with bipolar disorder, lithium is a commonly used medication. Studies suggest that lithium is very effective at both treating symptoms of bipolar disorder and preventing relapses of the condition.
Lithium may cause problems with kidney health. Kidney damage due to lithium may include acute (sudden) or chronic (long-term) kidney disease and kidney cysts. The amount of kidney damage depends on how long you have been taking lithium.
People taking lithium should avoid drinking alcohol. Not only can alcohol worsen bipolar disorder symptoms, but it can also intensify side effects caused by lithium, including dizziness and drowsiness. Additionally, taking lithium while drinking may make the medication less effective, leading to more mood swings.
It takes about 1 to 3 weeks for lithium to show the effects and remission of symptoms. Many patients show only a partial reduction of symptoms, and some may be nonresponders. In cases where the patient does not display an adequate response, consider monitoring plasma levels, and titrating the dose.
Take your lithium each night at the same time. You need to take it at night because blood tests need to be done during the day, 12 hours after a dose (see Section 4 'Blood tests after starting to take lithium').
Excessive urination and thirst (polyuria and polydipsia) are consistently found to be among the most common side effects associated with lithium with rates up to 70% in long-term patients (Bone et al.
2) Although not very common, weight gain is another adverse effect seen with chronic use of lithium. 3–5) An early study had found that lithium maintenance therapy stimulated weight gains of over 10 kg in 20%, which was attributed to increased thirst in majority of individuals.
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, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior.
In December 2021, the FDA approved Caplyta (lumateperone) to treat depressive episodes in bipolar 1 or 2 disorder in adults. It can be taken by itself or combined with lithium or valproate (Depakote). Caplyta is an oral capsule that you take once a day with or without food.
Lithium: The first mood stabilizer for bipolar disorder. Mood stabilizers are medications that help control the highs and lows of bipolar disorder. They are the cornerstone of treatment, both for mania and depression. Lithium is the oldest and most well-known mood stabilizer and is highly effective for treating mania.
What's the safest mood stabilizer? Medications such as Depakote and lithium may be more invasive in that they require consistent blood monitoring and potentially serious side effects. The medications that tend to be less problematic in regard to management and side effects include Neurontin and Topamax.