Lithium for Bipolars

Questions and Answers

Lithium is a simple element found in rocks and water and also in small amounts in the human body. In medicine it is used to prevent or lessen the severity of wide mood swing episodes in people who suffer from bipolar affective disorder (manic depression).  For treatment, lithium is used as a lithium salt, usually lithium carbonate (Li2Co3) and is taken orally in the form of tablets or capsules.

WHAT ARE THE SIDE EFFECTS OF LITHIUM?

If side effects occur they usually develop in the first several weeks of adjustment to the lithium therapy. 'Few patients show side effects of any consequence after this period. The usual side effects that can occur, and you should inform your doctor at your next regular visit1 are:  loose stools (not really diarrhea); a fine trembling of the hands: increased thirst; an increase in urination; feeling slightly ill or mildly nauseated; and a mild sleepiness or slight muscular weakness.

Other severe side effects which can occur  and should be reported to your doctor immediately, are: persistent diarrhea; severe nausea and vomiting; a marked dizziness; abnormal drowsiness; coarse trembling of the hands or legs;' difficulty walking; slurred speech; great discomfort or confusion; or swelling of the throat or neck.

If you cannot-contact your physician immediately, stop taking the lithium until you can get in touch. Also, if you have any doubt about side effects or some unusual symptoms that you are experiencing, consult your doctor right away.

WHY MUST I TAKE A BLOOD TEST?

The blood test measures the amount of lithium in your blood serum. From this test your doctor can determine the correct dosage for you. In the early part of treatment your blood is tested often until your doctor is sure of the proper dosage. From then on the tests will be done less frequently. If side effects should occur or your dosage needs to be changed for other reasons, it will be necessary to check your blood level more often until the proper level is reached again. Blood tests are taken 12 hours after your last dose of lithium. Most people find it convenient to take their last dose the evening before the test and their morning dose after the test. You can eat breakfast before 9 your blood test.

HOW WILL LITHIUM EFFECT ME?

Lithium is used to prevent the recurrence of wide mood swings. It has no sedative properties and does not interfere with your normal emotions or mental capacity. While taking lithium you can carry on with your normal daily activities, go to work or drive a car. You may drink alcohol in moderation if this is your usual habit.

Lithium is not a cure-all. Personal problems that resulted from mood swings prior to lithium treatment may still exist. Problems of everyday life will still exist. To help one resolve these problems one may choose to seek additional therapy. -- - - - -

IF I HAVE ANOTHER MANIC OR DEPRESSIVE EPISODE DOES THAT MEAN THE LITHIUM IS NOT WORKING?

Not necessarily. Lithium is used in preventing the recurrence of mood swings. For some people the effect is dramatic and they don't experience anymore mood swings. But, in most cases the mood swings become less severe, less frequent and shorter as therapy goes on.

There are some instances where lithium has had to be given for one or two years before it was fully effective.

You should not take matters into your own hands by discontinuing or increasing your lithium dosage. But do tell your doctor about the mood swings. A readjustment in your dosage is all that might be needed.

In some cases it may be necessary to take additional anti-manic or anti-depressive medication if lithium is not fully effective.

IS LITHIUM ADDICTIVE? No.

WILL LITHIUM TREATMENT EFFECT MY WEIGHT?

Some, but not all, people have a tendency to gain weight under treatment. Proper attention to diet and exercise can prevent this problem.

Patients must not go on crash diets or any other diets while on lithium without consulting their physician. A normal food and  water intake must be maintained to avoid an increase in lithium level in the body which can be poisonous.

Should your mouth feel dry and you drink more liquids than normal, try to avoid liquids high in calories since excess calories can contribute to weight gain.

IS THERE ANY SPECIAL DIET I MUST FOLLOW?

Your daily diet must include a normal amount of liquid and salt. You may also consume alcohol in moderation. If you are an alcoholic and taking lithium then no alcohol should be consumed.

 DIRECTIONS TO FOLLOW

1. Take the lithium dosage your doctor has prescribed especially for you. Taking less
lithium than prescribed may not be effective. Taking more can make you sick.

2. D0 NOT change your dosage if you should experience mood swinging. Consult your doctor.

3. A good habit to get into is taking your lithium with meals, unless your doctor has advised otherwise; your dosage is remembered more easily. You are less likely to feel nauseated if lithium is taken with some food in your stomach.

4. Maintain a diet with a normal amount of fluids and salt.

5. Do NOT take your morning dosage the day of your blood test, until after the test. If you forget and take your dose do not have your blood level test done that day.

6. Discuss with your doctor a method for making up missed dosages.

7. Most, but not all, other drugs can be safely taken with lithium. You should always consult your doctor before taking other drugs in the presence of lithium.

8. Lithium is an "insurance policy" against recurring episodes of manic depression. Do not make the mistake of not taking your lithium just because you feel better. You will be depriving yourself of the full benefits of lithium.

9. Inform your nearest relative or closest friend that you are being treated with lithium. We suggest that you read over these guidelines together and discuss them.
 

(Text prepared in 1977 by Lynda H. Wannamaker and James W. Jefferson, M.D. with the help of patients and friends.)

 

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