What You Need to Know About Taking Lithium

By Layne A. Gritti, DO

Adult, Addiction, and Perinatal Psychiatrist

What is Lithium and What Does it Treat?

Lithium is a mood stabilizer commonly prescribed for bipolar disorder, which involves episodes of depression and/or mania. It is also used off-label as an add-on treatment for depression. Lithium has been shown to reduce suicide rates.

Before You Start Lithium

Discuss any current symptoms, previous medications, medical or psychiatric conditions, and any other medications with your healthcare provider.

Concerns about Pregnancy/Breastfeeding: If pregnant, planning to become pregnant, or breastfeeding, inform your provider. This does not automatically mean you should or need to stop lithium; your healthcare provider will guide you. Please see my previous blog on this topic as well as this helpful fact sheet from MotherToBaby.org.

Taking Lithium

Lithium is typically taken 1-3 times per day, with or without food (check your medication bottle for how often your clinician wants you to take it). Generally the dose is 300 mg to 1200 mg daily.

What if I miss a dose? Take as soon as you remember unless it’s close to the next dose. Avoid doubling doses.

What to Avoid

Medications:

Avoid NSAIDs (e.g., ibuprofen, naproxen), thiazide diuretics, angiotensin receptor blockers, and certain antibiotics, as they can raise lithium levels.

Lifestyle:

Avoid alcohol, excessive caffeine, and illegal drugs. Stay hydrated, and avoid overheating.

Diet:

Avoid low-sodium diets and dehydration, as they may increase toxicity risk.

Monitoring Requirements

You’ll need regular blood tests to monitor lithium levels and kidney function, especially at the start. Levels will be checked more often initially and less frequently once stabilized.

Side Effects

Common Side Effects:

• Headache, nausea, diarrhea, dizziness, hand tremors, dry mouth, increased thirst, increased urination, hair thinning, and acne-like rash.

Serious Side Effects:

• Signs of lithium toxicity (see below) require immediate medical attention.

Long-term Side Effects:

• Hypothyroidism: Regular thyroid function tests are essential.

• Kidney Health: Long-term lithium use can affect kidney function, so routine monitoring is necessary.

What is Lithium Toxicity?

Lithium toxicity is a serious condition caused by high lithium levels. Recognizing symptoms early can help prevent severe health risks.

Early Signs of Toxicity:

• Nausea, vomiting, diarrhea

• Drowsiness, tremors, muscle weakness

• Increased thirst, frequent urination, blurred vision

Advanced Signs of Toxicity (Seek Immediate Help):

• Severe tremors, muscle twitching

• Slurred speech, confusion, severe drowsiness

• Seizures, irregular heartbeat, loss of consciousness

Emergency Actions if You Suspect Toxicity:

1. Stop taking lithium immediately

2. Seek Immediate Medical Help: Contact your healthcare provider, call 911, or go to the ER.

3. Inform Providers: Share your lithium use and any other medications or supplements.

4. Follow-Up Care: Regular follow-ups will be necessary to adjust dosage and monitor levels.

Preventing Lithium Toxicity

• Blood Tests: Regular monitoring of lithium levels.

• Hydration: Stay hydrated to reduce toxicity risk.

• Stable Salt Intake: Avoid sudden changes in your salt consumption.

• Symptom Awareness: Watch out for early signs of toxicity(as above).

• Follow Prescriptions: Take lithium exactly as directed.

Remember:

Lithium toxicity is a medical emergency. Always seek immediate help if symptoms arise.