Lithium medication

How much do you really know about lithium medication?

Despite all the misinformation, stigma and stereotypes, this is still the first line treatment for bipolar disorder or manic depression. The truth is that lithium is cheap, effective, proven, and safe. Get the facts before being sidetracked by Internet snake oil.

Sadly, many people who could benefit from the oldest, best researched, most natural and most proven bipolar treatment are discouraged by a lot of negative half-truths and myths - many propagated online by Internet sales people who are out to profit from their own products. 

Everyone has different treatment needs. Many people do better on other leading bipolar medications such as Depakote or Lamictal.

However despite Depakote being the number one prescribed bipolar drug in the US, a number of studies have shown that lithium is THREE TIMES more effective in preventing suicides.

My message is simple - I know lithium is not for everyone, but all my experience and research has convinced me that everyone should try it first to see. It has the most research, best track record and experts like Kay Redfield Jamison, psychiatric professor at Johns Hopkins and world renowned bipolar author and scholar proclaimed as recently as September 2007 that lithium is still the gold standard in bipolar care.

Other bipolar medications

My only side effect issue was with weight gain, which can be overcome by eating in a way which minimizes mood swings and avoids physical symptoms of bipolar such as metabolic syndrome, high blood pressure, diabetes, and so forth: The Bipolar Diet

Beware of snake oil and hidden agendas

Not everybody responds to lithium. Also, for some people the side effects are difficult.

This is not an argument that lithium is for EVERYONE!

However, lithium is not the bogeyman it is sometimes made out to be. Please keep an open mind, especially if your doctor believes lithium is the right place for you to start. In particular, don't let your decision be based on negative reports from sales people with their own agendas. Carefully examine web sites to see where their information comes from and whether it is possible they have a financial interest in steering you towards their own solution.

Still the gold standard . . .

Why is lithium still regarded as the first line treatment for bipolar symptoms?

The main reason is that it treats the broad range of bipolar symptoms more fully than any other medication. It is effective against both mania and depression, and it reduces the risk of suicide. As well as stabilizing mood, it slows down the frequency of cycling. Plus, we have the most research on it, it is much cheaper than new medications, and it is arguably the most "natural" medication, being based on a simple and naturally occurring mineral salt.

The downside

Lithium does require more proactive management than other medications. The level in the blood must be kept within a very narrow range. Too little and it is possible to slip back into mania or depression - too much and side effects may become unpleasant or you may even risk death or serious health problems from lithium toxicity.

How does lithium work?

Lithium medication

In 1998, University of Wisconsin researchers found that lithium keeps the quantity of the neurotransmitter glutamate stable and at optimal levels. Dr. Lowell Hokin, a University of Wisconsin professor of pharmacology, theorized that lithium works to control bipolar because of this stabilizing effect on glutamate receptors.

This does not seem to be the whole story of why lithium is effective and it does not explain why other mood stabilizers, that do not target glutamate, can also help.

All we can say for sure is that lithium decreases abnormal activity in the brain by correcting what are probably biochemical imbalances caused by genetics.

Common brands and doses

The common US brands are Eskalith, Eskalith CR and Lithobid. In Canada you will see Carbolith, Duralith and Lithane. Sometimes lithium meds come as simple generics are labelled with chemical names such as lithium carbonate or lithium citrate.

The form may be as a capsule, extended release tablet or a liquid solution.

Dosing may be 2-3 or 3-4 times per day, depending on how much you need and whether or not you are using the extended release version.

Usually each tablet, capsule or teaspoon of liquid contains 300 milligrams, bit 150, 450 and 600 milligram variations are also available.

Exact doses and dosing schedules will be based on your blood test results, body mass, diet, symptoms, and individual response. The goal is to minimize the dose in order to minimize side effects while also ensuring you maintain a high enough and constant enough level of lithium in your blood to prevent mood swings.

Patty Duke, for example, takes her "little beige pills" twice a day.

Lithium medication FAQ

Lithium medication for brain health

1. Is lithium addictive?                   

2. Does lithium cure bipolar?              
No. It is an effective treatment, but it is not a cure. Someone who stops taking their lithium medication will probably relapse.

3. Will I ALWAYS have to have blood tests? 
Yes. However these become needed far less frequently with time and today there is an innovative new test available that can be administered right there in the doctor's office.

4. How should lithium be stored?      
In a cool, dry, dark place, out of reach of children. Don't keep your lithium medication in the refrigerator or in the bathroom.

5. Does lithium require a prescription?
Yes! It also requires careful monitoring from an expert clinician who is experienced in looking after patients on lithium medication! This is NOT one of those medications to buy over the Internet!

6. What are some good sources of further information?
A nice easy read that still has plenty of detail is the excellent booklet, by James W. Jefferson & John H. Greist Lithium and Bipolar Disorder: A Guide, Lithium Information Center, Madison Institute of Medicine, 2004, available from Amazon for just $5.95.

Also see the lithium page from the US National Library of Medicine. Reliable, trustworthy and unbiased information on lithium medication is available in lay terms from two very experienced doctors: Jim Phelps MD and world expert, Dr Manji.

WARNING - Only read the above links from Dr Phelps and Dr Manji if you want some GOOD NEWS for a change!

Lithium medication patient education

Up to date, accurate and complete lithium patient education is proven to significantly enhance outcomes.

Medication compliance, symptom level, weight gain and quality of life are all on-going challenges for people taking lithium.

Patient education has been demonstrated by research to improve all of these problems.

Lithium medication patient education may focus on any of the following:

1. Taking medication as directed.

2. Understanding risk factors for relapse.

3. Recognizing warning signs for relapse.

4. Managing stress.

5. Identifying supportive strategies.

In fact, education is emerging as one of the most successful psychological and social interventions for bipolar disorder.

As well as improving medication compliance and attitudes to lithium, education has been shown to reduce relapses and improve socio-occupational functioning.

Drug companies who provide lithium medication routinely provide lithium medication patient education sheets along with the drugs. You have probably received one of these from your pharmacy.

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