A Close Look at Lithium
Written by - Bipolar Noise - Jan 2002
Brand Name/Manufacturer:
Lithium is widely used by individuals with Bipolar Disorder, including myself, so I decided to take a closer look. I wanted to know exactly how it works and what I might be facing down the road by taking it. Here is what I found out.
Lithium's effects on manic-depressive illness were discovered by chance in 1949 by an Australian physician named John Cade. He used lithium to treat gout in hamsters, and they calmed down.
Lithium is considered an antimanic drug. However, I am told by my doctor that it works for depression as well. I, personally, have not found that to be the case... I still have problems with severe depression while my mania is not as severe. So I am forced to take additional medication for depression.
Lithium is widely considered the first-line treatment for bipolar illness. However, the anticonvulsant drugs carbamazepine (Tegretol) and valproic acid (Depakote) are often used now. It is said that Lithium often does not work well for Bipolars with rapid cycling or mixed episodes. I have both. I am unable to tolerate Depakote; Tegretol does nothing for me.
They do not know how or why Lithium is able to control mania. This concerns me a bit. So my search for exactly why it works ended here. But I did find that it alters the cation (group of ions having a positive charge) transport in nerve and muscle cells and it affects the metabolism of catecholamines (neurotransmitters and hormones which include epinephrine, norepinephrine, and dopamine). It blocks the release of thyroxine(hormone produced by the thyroid gland to regulate metabolism) and triodothyronine (a thyroid hormone, similar to thyroxine but more potent, used in the treatment of hypothyroidism). Now, I'm not in the medical field so I can't say for sure what all that means, but in short it sounds as if it prevents certain hormones produced by your thyroid gland from being produced.
Lithium can produce an increased white blood cell count (neutrophilia). And it does cross the blood-brain barrier (a filter of sorts that prevents toxins that enter the blood from entering the brain). It is readily absorbed from the greater intestinal tract. 95% of Lithium is eliminated by the kidneys. Lithium is not metabolized.
So how much Lithium should we take? I have always been told that the minimum theraputic dosage for an adult was 900mg per day. Which is what I take. Here is what I found:
Dosages for Adults
Dose is based on serum drug level (level taken by blood test):
For acute episodes:
Usual serum lithium level: 1-1.5 mEq/L (Serum lithium concentration should not exceed 2 mEq/L)
- Tablets/capsules: 600 mg
- Sustained-release capsules: 900 mg
- Liquid: 30 mL (48 mEq)
For long-term control
Desired serum lithium level: 0.6-1.2 mEq/L (Serum lithium concentration should not exceed 1.5 mEq/L)
- Tablets/capsules: 300/mg
- Liquid: 15-20/mL (24-32 mEq)
Therapeutic levels are close to toxic levels. Lithium's therapeutic effects occur at dosages that are only slightly lower than the doses that would cause toxicity. Dosages are individualized with attention to serum levels and clinical response. Lithium levels are monitored on a regular basis by blood test. Individuals who are extremely sensitive to lithium may have toxic reactions at serum levels in the range of 1.0-1.5 mEq/L.
In long-term use of Lithium drug levels should be checked by blood test every 2 - 3 months. If there is a history of cardiovascular disease a periodic ECG should be performed. If there is a history of thyroid disease and annual T3, T4 and TSH concentration should be performed. (Possibly to do with the blocking of the hormones produced by the thryroid gland?)
Dosage Forms
Tablets (Lithium carbonate)
Controlled-release tablets (Lithium carbonate)
Film-coated tablets (Lithium carbonate)
Capsules (Lithium carbonate)
Generic Forms
Tablets (Lithium carbonate)
Capsules (Lithium carbonate)
Syrup (Lithium citrate)
Health Concerns
If you have any of the following conditions you should be concerned if taking Lithium:
Drug Interactions
Life-threatening:
Drug may increase effect, concentration, or risk of toxicity of Iodide salts Neuromuscular blocking agents Tricyclic antidepressants (TCAs).
Phenothiazines and lithium produce unpredictable reactions. Patients taking both lithium and any phenothiazine should be monitored for adverse neurologic effects.
Concurrent use of lithium with carbamazepine (Tegretol) or phenytoin (another anticonvulsant that I am unfamiliar with) has sometimes produced adverse neurologic effects. (I, personally, have taken Lithium and Tegretol at the same time with no problem.)
Calcium-channel blocking agents, including verapamil, may potentiate the toxic effects of lithium.
Lithium's hypothyroid effects may be heightened by potassium iodide or antithyroid drugs.
Over the Counter Drugs/Herbal Remedy/Nutritional Supplement Interactions
Life-threatening:
Drug effect, concentration, or risk of toxicity may increase if taken with Diuretics.
Nonsteroidal anti-inflammatory agents (NSAIDS) such as Advil and Motrin can effect levels or concentration may decrease if taken with Antacids or other drugs with high sodium concentrations.
Drug-Food Interactions
Drug effect, concentration, or risk of toxicity may increase if taken with excessive amounts of coffee, tea, or cola, due to diuretic effect.
Drug effect and/or concentration may decrease if taken with large quantities of salt and other sources of sodium.
Possible Side Affects
Other Comments
Eat something before taking Lithium to avoid stomach problems and nausea. Drink lots of fluids to prevent dehydration. Also avoid prolonged exposure to the sun because it can lead to dehydration.
