Lithium has served as a prescription medication in mental healthcare for decades. Reintroduced for psychiatric use in 1949, lithium salts are primarily recognized as mood stabilizers.
Lithium’s Role in Mood Regulation
Lithium is a highly effective treatment, particularly for bipolar disorder, where it helps stabilize mood swings and reduce the frequency and severity of both manic and depressive episodes. It is often considered a standard treatment for managing this condition. Evidence suggests lithium can significantly lower the risk of suicide attempts in individuals with bipolar depression.
For unipolar major depressive disorder, lithium’s role is typically as an adjunctive treatment when other antidepressants have not been fully effective. It can augment the effects of existing antidepressant medications, especially in cases of treatment-resistant depression. Some studies indicate it can be effective in preventing relapse in unipolar depression, particularly in chronic or recurrent forms, and may even have anti-suicidal effects in this population.
The precise mechanism by which lithium works to stabilize mood is not fully understood, but it is believed to influence several brain processes. It interacts with various neurotransmitters and receptors, potentially decreasing norepinephrine release and increasing serotonin synthesis. Lithium may also affect nerve cell communication by modulating glutamate levels, an excitatory neurotransmitter, and enhancing the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Additionally, it has been linked to neuroprotective properties, possibly by increasing certain brain-derived neurotrophic factors (BDNF) that support cell health and growth.
Managing Lithium Treatment
Lithium treatment necessitates careful medical oversight, including an initial assessment before starting the medication. This typically involves blood tests to check kidney and thyroid function, as well as electrolyte and calcium levels. Regular blood tests are crucial to ensure the lithium concentration in the body remains within the therapeutic range, which is often between 0.6 and 1.2 millimoles per liter, though lower targets may be used for maintenance.
Monitoring also includes periodic checks of kidney and thyroid function, usually every 6 to 12 months, because lithium can affect these organs over time. Dosage adjustments are made based on these blood test results and the patient’s clinical response. Consistent daily intake of the medication is important for maintaining stable levels.
Patients beginning lithium treatment should understand that therapeutic effects may take time to become apparent, and it is often a long-term treatment. Continued medical supervision, regular follow-up appointments, and adherence to monitoring schedules are essential for safe and effective management.
Potential Side Effects and Safety
Individuals taking lithium may experience various side effects, particularly when first starting the medication, though many can improve over time. Common side effects include increased thirst, frequent urination, mild hand tremors, and gastrointestinal issues such as nausea or diarrhea. Weight gain is also a possible side effect. Staying well-hydrated is important to manage increased thirst and frequent urination.
More serious, but less common, side effects can involve kidney problems or thyroid dysfunction, which is why regular monitoring of these organs is necessary. A significant concern is lithium toxicity, which occurs if blood levels become too high. Symptoms of lithium toxicity can range from mild to severe and include worsening tremor, confusion, slurred speech, unsteadiness, muscle weakness, and, in severe cases, seizures or coma.
Patients should immediately report any unusual or severe symptoms to their healthcare provider. Factors like dehydration, changes in salt intake, or interactions with other medications can increase the risk of lithium toxicity.