Bipolar Disorder - When we use Lithium

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Lithium is the first recommended treatment for bipolar disorder, but only when you have classic bipolar disorder. Classic bipolar disorder is when you have a clean separation between depressive episodes and manic episodes. I've defined depression and mania in several videos that are grouped into my bipolar disorder playlist.

A clean separation means that when one episode is over, you return to your baseline until the next episode comes. You don't have lingering depression with anxiety mixed in.

Lithium is not a good choice when you have a mixture of mania and depression symptoms happening at the same time. We call this bipolar disorder with mixed features. So you have the hyperarousal of mania where you are sped up, you may be impulsive, using poor judgment, irritable or angry while also having at least 3 depressive symptoms with your mania. I describe this in more detail in my mixed mania video.

In the case of mixed features, the recommended first choice is an antipsychotic medication like quetiapine. We use the second generation antipsychotic medications as mood stabilizers in bipolar disorder.

One thing that lithium does that the other medication don't do as well is it reduces suicidal thinking. The only other medication that addresses this at the same level is ketamine, which we use for treatment resistant unipolar depression.

Side effects of lithium
Lithium can cause weight gain, tiredness, and fuzzy thinking similar to some of the other mood stabilizers. But Lithium also has some side effects that can come with long-term use. Lithium can cause your thyroid to malfunction such that you start to produce inadequate amounts of thyroid hormone.

The second long-term side effects is to your kidneys. Everyone has some decline in kidney function as you get older. But long-term lithium use can accelerate this process. You can also get a condition called diabetes insipidus. This is different from diabetes mellitus where you get elevated blood sugar levels. With insipidus, your kidney loses its ability to concentrate your urine. You get frequent urination and excessive thirst.

Diabetes insipidus can happen even within the first weeks to months of taking lithium. In usually resolves on its own, but it can persist in about 25% of people. Sometimes this problem can be helped by taking your lithium all at once at bedtime. If the problem doesn't go away, then it's probably best to switch to a different mood stabilizer. If you catch it early, it's reversible usually within weeks.

Another way lithium can damage your kidneys is if it gets too concentrated in your blood. It can reach toxic levels and damage your kidneys. That's why it's important to have your lithium levels checked on a regular basis and you have to make sure you stay hydrated. If you loose a lot of fluid from excessive sweating, diarrhea or vomiting, watch carefully for signs of lithium toxicity.
Early signs of lithium toxicity are tremor, slurred speech, feeling tired and weak. You can also get diarrhea and vomiting from the toxicity. If you started feeling this way, you should get yourself to an emergency room or urgent care to be evaluated.

If you are on lithium, make sure all of your doctors know so they can check for any drug interactions from medications they prescribe. Also, if you have pain problems, watch your consumption of non-steroidal anti-inflammatory medications like Advil or Aleve. This class of medication can increase lithium levels.

What about lithium orotate?
This is a version of lithium that is available over the counter. It's a much lower dose of lithium than what you get with prescription lithium. The prescription versions are lithium carbonate and lithium citrate. Because you are still taking lithium, you are still susceptible to the risks that you have with prescription lithium.

Links to videos
Bipolar Playlist    • Bipolar Disorder vs Depression - 5 Signs Y...  
Mixed mania    • What is Mixed Mania and How Do We Treat It?  

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.