Q:  Can Long-term Lithium Use Cause Brain Damage?

I am 51 years old, I was diagnosed with Bi-polar disorder when I was 24/25 yrs old.  For over half my life I have been taking Lithium 800 mg.  I have an underactive thyroid, and also have psoriasis which also affects my fingernails and toenails, this being more problematical over the last 5 years I was thin before I started the Lithium but my weight has gained and I am overweight, again more so over the past 5 years.  I have been hospitalised 4 times for mania and once for deep depression. And spent most of my life in a fog of despair trying hard to fit into a 'normal' world. I presently take Cipramil 20mg along with my Lithium. I find I get tired easily, severely lack confidence, and am often depressed and anxious about the future.  I read recently that long term Lithium use can cause brain damage! is this true? if so, is it reversible, and what other treatments could I use?  I would appreciate your reply.  Thank you, 
Marion   


Dear Marion --

Well now, there are quite a few issues in here. Ideally, it would be nice to take on the "fog of despair". That sounds awful. It is unfortunately beyond what I can address here; so I'll take the easier one: does lithium cause brain damage?

For starters, this is probably a pretty good example of the dangers of the Internet as a source of information. When you see somebody make an assertion like that, you will want to ask "where's the evidence?" If you can go back and actually find that particular statement, I would be interested in knowing where you found it, if you could send me the reference (an Internet address, for example). You can send it to me here at Bipolar World, because I would write a little essay about it.

The short version of that essay: wrong. I could almost stop there. But that would be no better than what you already read -- where is the evidence? In fact, the evidence for what long-term lithium does to the brain is actually quite the opposite. Or to be more precise, there is evidence that long-term lithium has a very beneficial effect on the brain, at least in people who have bipolar disorder. It can keep the brand from shrinking, at least to some degree, and in fact can help the brain grow back in some of the regions that are shrinking in people who have severe mood problems. The evidence for this is detailed on page on my website called "can the shrinkage be reversed?" (This is mini-chapter 11; you might want to start with mini -Chapter 6 to appreciate the story).

It is true that getting too high a lithium level can cause damage to your brain. But I am not aware of any evidence that therapeutic levels of lithium can do this, or anything like it. Again, I think the evidence is to the contrary, as noted above.

Thank you for the question. That is an important one.

Dr. Phelps