Lithium for bipolar disorder: What to know

When you have bipolar disorder, manic and depressive episodes can disrupt your life and impact your overall well-being. Psychiatric medications can play a big role in bipolar disorder treatment, preventing frequent mood episodes and relieving acute symptoms within a manic or depressive episode.

One effective bipolar disorder treatment that’s stood the test of time is lithium. The medication has been used for centuries, and was FDA-approved for bipolar treatment in 1970.  

Read on to learn about what lithium is used for, its pros and cons, side effects, and alternative medication options for bipolar disorder treatment.  

What is lithium used for?

Lithium is a mood stabilizer used for treating bipolar I disorder in children and adults ages seven and up. It has two specific indications within bipolar disorder treatment:

• Maintenance treatment of bipolar disorder 1

• Treatment of acute mood episodes (manic or mixed)  

The drug is available in the following forms:

• Lithium oral solution

• Lithium carbonate tablets

• Lithium carbonate capsules

• Lithium carbonate extended-release tablets

Lithium is commonly prescribed in generic form, but it is also available under the brand name Lithobid.  

To keep levels of lithium stable in your blood throughout the day, you must take the medication in divided doses. The starting dose of lithium is 300 mg, three times daily. From there, your provider will conduct blood tests to determine the amount of lithium in your blood and assess if you need a higher or lower dose.  

However, the general goal for dosage is:

• 600 mg taken two or three times daily for an acute mood episode

• 300 mg to 600 mg taken two or three times daily for maintenance treatment

Individual doses may vary depending on your weight and blood test results checking lithium levels.

Off-label uses

Although lithium is only FDA-approved to treat bipolar disorder, some doctors might prescribe it “off-label.” This means the drug is used for a reason other than its approved use, based on available positive research. Off-label uses of lithium are:

• An add-on treatment to an antidepressant for major depressive disorder (MDD)

• Maintenance treatment of bipolar disorder without mania

• Treating neutropenia

• Treating vascular headaches  

How does lithium work?

According to the FDA, the exact mechanism of action of lithium for mood stabilization is not known.  

However, one potential theory is that lithium helps regulate neurotransmitters, which are chemical messengers in the brain. It may also impact cellular signaling pathways in the brain, which can help regulate mood.

Pros and cons of lithium

Before you start taking lithium, it’s important to consider both the benefits and risks of the drug. Here are some key points to review. A psychiatrist can help you weigh the pros and cons, determining if the benefits outweigh the risks in your particular situation.  

Pros

• Helps relieve acute manic or mixed episodes  
• Helps prevent manic episodes  
• Reduces suicide risk  
• Long history of use (FDA-approved in 1970) with extensive research support of the drug’s efficacy  
• Generally affordable in generic forms
• Often called the “gold standard” treatment for bipolar disorder

Cons

• Not FDA-approved for bipolar II  
• Need blood tests to monitor lithium levels in the blood to ensure safety
• May cause harm to a fetus while pregnant or a newborn while breastfeeding
• Risk of side effects such as nausea, trembling hands, excess urination, and more.  
• Risk of serious, dangerous adverse effects like lithium toxicity, serotonin syndrome, or other health conditions.
• Need to be careful of drug interactions with medications like non-steroidal anti-inflammatory drugs (NSAIDs), antipsychotics, serotonergic drugs, and more.
• May not be as effective for managing acute depressive episodes

What are the side effects of lithium?

You may experience side effects while taking lithium, especially when you first start taking the drug.  The most common side effects of lithium in adults are:

• Nausea

• General discomfort

• Trembling hands

• Feeling more thirsty than usual

• Excessive urination
  

The most common side effects of lithium in children and teens are:

• Nausea

• Vomiting

• Dizziness

• Trembling hands

• Blurred vision  

• Loss of appetite

• Rash

• Feeling more thirsty than usual

• Excessive urination

• Thyroid problems (it’s important to get a kidney and thyroid screening prior to starting lithium)

Typically, side effects will subside within a couple of weeks as your body adjusts to the medication. Tell your doctor if any side effects won’t go away or worsen.

Rare but serious side effects

There are some more rare but serious risks of Lithium to consider, too, including:

Lithium toxicity: This occurs when there’s too much lithium in your blood. It’s dangerous and potentially fatal. If you have any symptoms that indicate lithium toxicity, don’t take your next dose of Lithium, and call your doctor right away. Some symptoms of lithium toxicity overlap with general side effects, but always tell your doctor just in case. It’s better to be on the safe side. Signs of lithium toxicity include:

• Vomiting

• Diarrhea

• Muscle weakness

• Twitching muscles

• Blurry vision

• Abnormal heartbeat  

• Ringing in ears

• Clumsiness

• Drowsiness

• Slurred speech

• Confusion  

• Feeling lightheaded

• Trouble breathing

• Seizures

• Coma

Serotonin syndrome: This occurs when you have dangerously high levels of serotonin. Lithium on its own can cause this, but it’s even more likely to occur if you take any other drugs that also affect serotonin. Call your doctor immediately if you have any symptoms that could indicate serotonin syndrome.  Some warning signs include:

• Nausea and vomiting

• Diarrhea

• Confusion

• Fast pulse

• Sweating

• Fever

• Tremors

• Muscle twitches

• Stiff, rigid muscles

• Seizures

• Coma

Hyponatremia: This is when you have dangerously low sodium levels. You might have a fever, sweating, diarrhea, and confusion.

Polyuria: This is a scenario where your body produces excessive amounts of urine, which might lead to dehydration, harm to the kidneys, or hyponatremia.

Lithium-induced chronic kidney disease: Lithium may possibly cause harm to your kidneys. It’s crucial to have your kidney function tested before you start lithium to ensure your kidneys are healthy to begin with.

Encephalopathic syndrome: This is a neurological side effect that could result in brain damage if you don’t identify it or seek treatment. Warning signs are tremors, fever, weakness, and confusion.

Hyperthyroidism or hypothyroidism: Lithium may cause you to have an overactive or underactive thyroid, which can cause various health problems. It’s important to have regular thyroid testing while taking lithium.

Hypercalcemia: This is when the calcium levels in your blood are too high, which can result in various complications. Hypercalcemia is also linked to hyperparathyroidism, another lithium complication that raises your calcium levels.  

This is not an exhaustive list of mild or severe side effects and risks. Make sure you talk to your doctor if you have concerns about side effects, future risks, or drug interactions.  

What are alternatives to lithium?

If lithium isn’t the right fit for you, there are other medications for bipolar disorder. Examples of drugs are:

• Anticonvulsants (seizure medications) that act as mood stabilizers (such as Lamictal or Depakote)

• Atypical antipsychotics (like Abilify or Risperdal)

• Antidepressants used alongside a mood stabilizer  

A psychiatrist will be your best guide to determine what medication is best for you, whether or not it’s lithium.

Psychotherapy can also play a big role in bipolar disorder treatment. A therapist can help you identify and reframe unhealthy thoughts related to your mood episodes, giving you coping skills to deal with difficult mood episodes. Some examples of therapy used for bipolar disorder management are:

• Cognitive behavioral therapy (CBT)

• Dialectical behavior therapy (DBT)

• Interpersonal and social rhythm therapy (IPSRT)

• Family-focused therapy (FFT)

• Group psychoeducation  

• Psychodynamic talk therapy

If you’re looking for a psychiatrist to help you manage your bipolar disorder, consider Talkiatry.  

We’re a national psychiatry practice that treats a wide variety of mental health conditions, including mood disorders like bipolar depression. We provide virtual, in-network services so you can get the care you need from the comfort of your home. To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

What are the risks of taking lithium?

As with any other medication, you run the risk of side effects. Typically, these side effects subside with time. However, there is also a chance of more rare and serious adverse effects such as lithium toxicity, serotonin syndrome, impacts on kidneys and thyroid, and more.  

Is lithium effective for bipolar disorder?

Yes, lithium is effective for bipolar disorder, especially bipolar I disorder. Research over the years has shown that lithium is effective in preventing manic episodes and relieving episodes of acute mania.  

What are the symptoms of bipolar disorder?

Bipolar disorder symptoms can be divided into two groups: manic symptoms and depressive symptoms.

Manic symptoms include:

• Abnormally high, elevated mood

• Irritability

• Feeling wired

• Racing thoughts

• Impulsive behaviors

• Feeling like you don’t need sleep

• Talking fast or erratically

Depressive symptoms include:

• Feeling sad and depressed

• Restlessness

• Sleep troubles (insomnia or sleeping too much)

• Talking slowly

• Irritability

• Forgetfulness

• Loss of interest in things you usually enjoy

• Hopelessness or worthlessness  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.