Lithium

Why have I been prescribed lithium?

Lithium is used for mania and as a mood stabiliser in people with bipolar illness and will reduce the number and degree of mood swings you experience. It is also used as an additional medication to help people with depression that has not responded to a single anti-depressant. You may wish to discuss this with your prescriber who will be able to give you more information.

Medication is just a part of the management of the illness. Other therapies are also helpful; you may wish to discuss these with your prescriber.

What exactly is lithium?

In this instance lithium is being used as an antidepressant or mood stabiliser. It is not a tranquilliser or sleeping tablet. It comes as both tablets and a liquid. There are different brands of lithium which release the lithium into your stomach differently.

Is lithium safe to take?

It is usually safe to take as prescribed by your prescriber but like many medicines will not suit everyone. Let your prescriber know beforehand if any of the following apply to you:

  • A known allergy to lithium
  • Heart disease
  • Kidney problems
  • Untreated hypothyroidism
  • Low sodium levels or on a low sodium (salt) diet
  • Addison’s disease
  • Brugada syndrome or family history of Brugada syndrome
  • Pregnant or breastfeeding
  • If you are taking other medication; this includes prescribed medication such as diuretics (particularly thiazide diuretics), pain killers (non-steroidal anti-inflammatory drugs), or any medicines bought over the counter from your pharmacy, including herbal remedies

Before starting, the prescriber will carry out a series of test to make sure there are no problems such as with your kidneys, heart and thyroid. They will discuss the results with you.

What is the usual dose of lithium?

The dose of lithium will depend on the result of blood tests which measure the amount in you body. The normal dose range will be in the range of 200mg to 1000mg but may be higher depending on blood test results.

How should I take my lithium?

Follow the directions on the label. The tablets are normally taken as a single dose at night and the liquid in divided doses twice a day. The tablets must be swallowed whole. If you have any questions, ask your pharmacist, nurse or prescriber. You should also read the information leaflet supplied with the medication.

What should I do if I miss a dose?

If you miss a dose and it is within a few hours of the normal time, continue to take it as normal. If it is longer, miss the dose and continue as normal when the next dose is due. Never double up on the dose. The tablets must be swallowed whole.

When I feel better, can I stop taking lithium?

Depression:
No, if you stop your lithium too early, your symptoms may return. To reduce the chances of this happening, it is advised you should continue to take it for at least 6 months after you become well and sometimes longer. You should discuss this with your prescriber.

Bipolar illness:
Lithium is intended to keep you well. Most people will need to be on it for at least five years if it suits you. If it is stopped suddenly, there is a risk that it may cause you to have a manic episode; as such should always be stopped gradually.

Is lithium addictive?

Current literature does not suggest that lithium is addictive. While there is no clear evidence of withdrawal or rebound psychosis, abrupt discontinuation of lithium increases the risk of relapse. If lithium is to be discontinued, the dose should be reduced gradually.

What will happen to me when I start taking lithium?

All antidepressants work slowly and in this case it will take a while to get to an effective dose. Although some people notice a change in the first week, normally it will take several weeks for the anti-depressant to have its full effect. If it is being used as a mood stabiliser, it may take months to find out how effective it is. This will depend on how often you normally have mood swings.

After about 5 to 7 days the prescriber will take a blood test to measure the amount of lithium in your body and will adjust the dose depending on the results. They will check the levels weekly until they are stable, after which the prescriber will check your levels every three months.

As with all medication lithium does have side effects. You may well experience these before you start feeling the benefits. Most side effects are short lived and will pass with time. The following table contains some of the more common and more important side effects of lithium and what to do about them. It is not a complete list and not everyone will get all of those listed. Ask your pharmacist, nurse or prescriber if you are worried about anything else you notice that you think might be a side effect.

For details of the side effects table, please follow this link: Lithium

The prescriber will carry out regular blood tests to ensure the safety of your treatment.

This list is not a complete list of all known side effects. If you notice anything else you are not sure of, speak to a, nurse, pharmacist or your prescriber. You should read this together with package insert.

Signs of toxicity

High levels of lithium can be dangerous. You should be aware of the signs to look for. If any of these occur you should stop taking the lithium and contact your prescriber straight away:

  • Blurred vision
  • Nausea, vomiting
  • Drowsiness or feeling sleepy or sluggish
  • Unsteadiness on your feet
  • Increasing confusion
  • Slurring of words (it is difficult for others to understand what you are saying) Severe hand shake (“tremor”)
  • Muscle twitches
  • Muscle weakness
  • Increased thirst or passing more urine
  • Unusual clumsiness

Many things can affect the way your body deals with lithium. Avoid situations when you are likely to sweat profusely and if you do, you should ensure you drink plenty of fluid and maintain a reasonable intake of salt.

What about alcohol?

Ideally do not drink alcohol when taking this medication. This is because taking them together can make you more drowsy, sometimes severely. There is no safe drink and drive limit when taking this medication. Once people have been taking this medication for some time, they may be able to take small amounts of alcohol. Try a small amount in a safe environment and see how you feel. Ideally get someone else to tell you.

Useful information

talking-shop-leafletPlease click on the image to the left or follow this link to download a copy of our Lithium leaflet.