Q: Three Important Questions re. Lithium
Is it true that it is better to take lithium by itself than also with an
antidepressant? (For better effects?). Does lithium literally rot your teeth
from the inside out, or cause other dental problems? Should I only take my
lithium when I feel myself going in a "low"? Thank you for your time--please
Dear Jessica --
Well now, you raise three important questions.
First, is lithium better alone than with an antidepressant? This question sounds
simple enough, but it leads to an incredibly complex story. Let's see if I can
give you the bottom line and let you pursue more information if you wish.
A) in the opinion of most mood experts, the mainstay of medication treatment of
bipolar disorder is the group of medications called "mood stabilizers". Lithium
as one of the prime examples in this class of medications.
B) in general, most mood experts believe that antidepressants have the potential
to make bipolar disorder worse, and should be avoided if not clearly necessary,
instead relying on mood stabilizers to prevent depression from returning.
Therefore, in general, without looking at your particular circumstances, the
starting assumption amongst many mood experts would be that lithium alone will
work as well as or better than any lithium/antidepressant combination. There are
several research studies which support this conclusion, including a recent major
study in the New England Journal of Medicine. You can find a more general
discussion of the role of antidepressants in the treatment of bipolar disorder,
from my personal point of view, but gathering together much of the research on
this, on my webpage entitled "Antidepressant
However, for you personally, it may be very important to combine lithium with an
antidepressant. That would be a conclusion that is up to you and your
psychiatrist. Please do not interpret my answer as a comment upon whether an
antidepressant is right for you. I am simply answering your question in general
terms. Do not stop your antidepressant (or your lithium!) And without discussing
these ideas further with your provider.
As for the second issue, lithium and dental problems: I had to go look that one
up. I have never heard of any such concerns. Interestingly, using a Google
search for "lithium dental", I found an article from the 1970s, a two paragraph
letter to the editor, in which a physician describes a concern about lithium
worsening the risk for cavities in one's teeth ("dental caries"). This citation
was about fifth on the list of links, following two articles which were studying
rats trying to determine if lithium might actually enhance the effects of
fluoride on preventing dental caries (it did not).
Repeating that search using
Pub Med, for a more
research oriented approach, yielded a few articles written by dentists,
commenting on oral hygiene in patients with bipolar disorder. From these, I
think it is fairly clear that the concern amongst dentists is not about a direct
effect of lithium on the health of one's teeth. Rather, if there is any effect
of lithium on dental health at all, it is probably through having a dry mouth
much of the time. That is not good for teeth, which are protected by elements in
From what I can see, you can completely eliminate the risk of any effect of
lithium on your teeth by simply drinking plenty of water (obviously one would
not want to use sugared soft drinks for this purpose!).
Finally, for your third question: this one is easy. The
whole idea of taking lithium, for most people (perhaps not in your circumstance,
although I would doubt this), is to prevent future episodes of mood problems.
Therefore the whole idea is to take it when you are well, in order to stay well.
At least this is how we generally use it in most people.
Thank you for your interesting questions. Good luck with your discussions with
your doctor about all this.
Published July, 2007