Q:  Treatment Choices for Those w/One Kidney

Hi.  I have just been diagnosed with bipolar disorder.  My doctor has given me two weeks to consider treatment options.  His first recommendation is Lithium, however I have had a Kidney removed and can't take any chances with my remaining one.  My doctor has advised that there will be regular blood tests to ensure there is not toxicity and damage to the kidney.  I can't afford to take any chances so do I medicate Bipolar Disorder and risk my kidney or do I try to live with Bipolar Disorder and treat the highs/lows when they occur?  Any advise would be appreciated.  Thanks.


Dear LM -- 
I understand the dilemma. I agree with the doctor: the kidney problems associated with lithium (with some rare exceptions, outlined in the kidney section of my review on the safety issues of using lithium) are easily monitored with very standard lab testing.  

You're in the same position as someone who has a family history of diabetes being offered one of the new-generation antipsychotics, which we know can push people toward diabetes (indeed, if you don't use lithium, you'd very likely be looking at one of these as among the next options).  Your likelihood of the feared medication risk is higher, to start, than other people.  But that doesn't mean you couldn't use one of the new-generation medications, if you had such a family history, for example. It just means you might want to monitor even more closely than usual (in that case, watching glucose levels perhaps every month for a while, instead of every three months as is the usual recommendation). 

Finally, I might just call to attention your phrasing there at the end: you have many more choices than to either risk your kidney or "live with Bipolar Disorder and treat the highs/lows when they occur".  There are at least 4 other medications widely recognized as "mood stabilizers" other than lithium, all of which, like lithium, would be used with a goal of preventing the highs/lows rather than waiting for them to occur. I hope you've already been introduced to that list, but if not, you'll find those with evidence for their effectiveness on my Mood Stabilizers page.

Dr. Phelps