The development of lithium as a therapeutic medicine was a significant medical advancement, especially within the field of mental health. Although the lithium drug has now been in use as a treatment for several decades and for several conditions, the lack of reliable information about lithium therapy has prevented many people from considering lithium treatment.

What Is Lithium?

Many people wonder, “What type of drug is lithium?” Lithium is a naturally occurring element found throughout the earth’s surface, and it is used for a wide variety of purposes, from ceramics to battery manufacturing.

Along with sodium and potassium, lithium is an alkali metal, a group of elements on the left side of the periodic table that are highly reactive and found only in their salt forms. Certain salts of lithium can treat several disorders. Understanding what lithium is can be achieved by understanding the fascinating history of lithium and its role in medicine.

Background and History

The history of lithium begins with its discovery in 1817. The name lithium comes from the Greek word lithos, meaning stone, (for example, a urolith is a medical term for a kidney stone). The name originates from the fact that, unlike its chemical siblings sodium and potassium, lithium was discovered within a rock.

The history of lithium in medicine began several decades after lithium’s discovery. Laboratory testing in the mid-1800s found that lithium could dissolve the urate crystals found in gout, and so — in theory, at least — lithium could be a treatment. At the time, gout was thought to be linked to several types of mental health disorders, including mania and depression. Scientific journals even once called depression brain gout. When this link was found to be incorrect, the use of lithium as an effective treatment for depression and mania disappeared with it, and it would not be used again significantly for nearly 40 years.  

Use in Treating Mental Illness

In 1949, an Australian psychiatrist researching schizophrenia treatments found that lithium had a tranquilizing effect on rats. Like many a bold scientist of that era, he ingested some of it to convince himself that it was safe. When lithium was found to be an effective treatment for the mania experienced by chronically hospitalized patients, the use of lithium for mental illness was rapidly adopted.

Lithium is approved by the United States Food and Drug Administration (FDA) as a first-line medication to treat the manic episodes of bipolar disorder, and as a maintenance medication for bipolar disorder. However, in practice, lithium is prescribed for a host of conditions, including major depressive disorder that hasn’t responded adequately to antidepressant treatment. Other non-FDA-approved uses of lithium for mental health include the treatment of eating disorders, schizophrenia, cluster headaches and many other conditions.

Lithium and Bipolar Disorder

The medical community strongly associates lithium and bipolar disorder. Lithium is considered the gold standard for treatment of nearly all forms of bipolar disorder, and it has been approved to treat mania in the United States since 1970. While the exact mechanism of lithium’s actions is unknown, lithium has repeatedly proven effective in reducing both the frequency and severity of manic symptoms.

Precautions When Taking Lithium

Lithium has a limited dose range before its therapeutic effects become harmful, which is known as a “narrow therapeutic index” among health care providers. Additionally, small changes in lithium blood levels can create dramatic changes within the body. For these reasons, lithium blood levels must be measured regularly. Since lithium toxicity or overdose are serious medical issues, lithium precautions always include strict adherence to the prescriber’s instructions.

Lithium Side Effects

Lithium has a reputation for its significant side effects. While lithium’s side effects profile is no longer or shorter than comparable medications, its severe side effects can be fatal if not treated.

Common lithium side effects include:

  • Increased urination
  • Shakiness of the hands
  • Increased thirst

Serious lithium side effects include:

  • Lithium toxicity
  • Diabetes insipidus
  • Hypothyroidism
  • Generalized weakness

Symptoms of lithium toxicity include (from most common to most concerning):

  • Nausea
  • Vomiting
  • Diarrhea
  • Changes in an electrocardiogram, or EKG
  • Tremors
  • Fatigue
  • Confusion
  • Agitation
  • Heart block
  • Hyperthermia (temperature elevation)
  • Hypotension (decreased blood pressure)
  • Seizures
  • Coma

The most concerning long-term side effects of lithium are toxicity of the kidney and hypothyroidism. Lithium’s anti-thyroid effect is even occasionally used to treat symptoms of hyperthyroidism.

Possible Interactions

Taking lithium requires being cautious about its interaction with other drugs.

NSAIDs

One of the more common lithium drug interactions is with non-steroidal anti-inflammatory drugs, or NSAIDs. This group of medications includes ibuprofen, indomethacin and several others. The combination of lithium and NSAIDs can reduce the clearance of lithium through the urine, and thus greatly increase lithium blood levels. This effect can potentially lead to lithium toxicity and other serious side effects when lithium and NSAIDs are taken together.

Diuretics

Another well-known lithium drug interaction is with diuretics (also called water pills) like Lasix or hydrochlorothiazide (HCTZ), which are drugs that help lower blood pressure by making the body excrete sodium. Since diuretics can cause dehydration, and sodium and lithium are chemically similar, the action of diuretics can sharply increase the level of lithium in the bloodstream.

Alcohol

Since alcohol intake can cause dehydration as well, lithium and alcohol can also have a dangerous interaction. Additionally, alcohol has a depressant effect on the central nervous system and may have negative effects on the mood and mental health on a person who is taking lithium.

Taking lithium and antidepressants like selective serotonin reuptake inhibitors (SSRIs) is generally considered safe and does not usually result in serious interactions.

Taking Lithium While Pregnant

Lithium is considered unsafe for prenatal use and may be harmful to a fetus. The largest study of taking lithium while pregnant found that a fetus that was not exposed to lithium had a 4 percent chance of having an abnormality, and a fetus that was exposed to lithium had a 7 percent chance of an abnormality.

However, medical experts agree that the risk of a fetal abnormality if taking lithium while pregnant has to be weighed against the possibility of worsened mental illness without lithium. Lithium is considered safe for breastfeeding in babies who have no problems with normal urinary clearance.   

What to Do in Case of Overdose

A lithium overdose is a medical emergency, and emergency services like 911 should be contacted immediately if a lithium overdose is suspected. Lithium overdose symptoms may include:

  • Nausea, vomiting or diarrhea
  • Tremors
  • Heart block
  • Hyperthermia (temperature elevation)
  • Hypotension (decreased blood pressure)
  • Seizures
  • Coma

In the emergency room, providers may administer medication to prevent lithium from being absorbed. The primary treatment for a lithium overdose is the administration of large amounts of fluids to help the body quickly clear any lithium that was absorbed.

Get More Information on Lithium

The Recovery Village has a vast collection of information on medications like lithium and other treatments for mental health conditions like bipolar disorder, major depressive disorder, eating disorders and many other conditions. With trained and caring experts who can assist in finding help for these conditions, The Recovery Village is ready to help you live in a way that supports your potential to the fullest.

If you or someone you love needs help for a mental health condition treated with lithium, call The Recovery Village today. Our facilities offer high-quality treatment for drug use disorders and co-occurring mental health conditions. The call is free and confidential, and there is no obligation to commit to treatment.

    

Marmol, F. “Lithium: Bipolar disorder and neurodegenerative diseases Possible cellular mechanisms of the therapeutic effects of lithium” Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2008. Accessed April 2019.

Felber, W. “Lithium Prophylaxis for Depression 100 Years Ago – an Ingenious Misconception” Fortschr Neurol Psychiatry, 1987. Accessed April 2019.

Shorter, E. “The history of lithium therapy.” Bipolar Disorder, 2009. Accessed April 2019.

Armstrong, C. “ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation.” Am Fam Physician, 2008. Accessed April 2019.

Munk-Olsen T, Liu X, Viktorin A, et al. “Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies.” The Lancet Psychiatry, 2018. Accessed April 2019.

Hedya SA, Swoboda HD. “Lithium Toxicity.” U.S. National Library of Medicine, updated March 26, 2019. Accessed April 2019.

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