What You Need to Know About Taking Lithium
By Layne A. Gritti, DO
Adult, Addiction, and Perinatal Psychiatrist
What is Lithium and What’s The Big Deal About It?
Lithium is a mood stabilizer and the “gold standard” for treating bipolar disorder, which involves episodes of depression and mania. It is also used off-label as an add-on treatment for depression. Lithium has been shown to reduce suicide rates.
Taking lithium requires regular monitoring via blood levels, kidney function, and thyroid. Levels are checked more often when starting with the or increasing the dose and less frequently once on a consistent dose.
It is important to monitor the level of lithium because if the dose is too high, someone taking lithium can develop lithium toxicity. It is also important to avoid some medications, stay hydrated, and make a few more lifestyle changes (as below).
Taking Lithium
Lithium is typically taken 1-3 times daily, with or without food (check your medication bottle for how often your clinician wants you to take it). Generally, the dose is 150 mg to 1200 mg daily.
What if I miss a dose? Take as soon as you remember unless it’s close to the next dose. Avoid doubling doses.
Concerns about Pregnancy/Breastfeeding: If pregnant, planning to become pregnant, or breastfeeding, inform your clinician. This does NOT automatically mean you should or need to stop lithium!; Please see my previous blog on taking mental health medications during pregnancy and breastfeeding as well as this helpful fact sheet.
What to Avoid
Medications: Avoid NSAIDs (e.g., ibuprofen, naproxen, aspirin, celecoxib, meloxicam), thiazide diuretics, angiotensin receptor blockers, and certain antibiotics, as they can raise lithium levels. Regarding over-the-counter pain meds, the safest thing is to stick to acetaminophen.
Lifestyle: Avoid alcohol, excessive caffeine, and illegal drugs. Stay hydrated(!), and avoid overheating.
Diet: Avoid low-sodium diets and dehydration, as they may increase toxicity risk.
Side Effects
Common Side Effects: Headache, nausea, diarrhea, dizziness, hand tremors, dry mouth, increased thirst, increased urination, hair thinning, and acne-like rash.
Serious Side Effects: Signs of lithium toxicity (see below) require immediate medical attention.
Long-term Side Effects to Monitor For
• Hypothyroidism: Regular thyroid function tests are essential.
• Kidney Health: Long-term lithium use can affect kidney function, so routine monitoring is necessary.
What is Lithium Toxicity?
Lithium toxicity is a serious condition caused by high lithium levels. Recognizing symptoms early can help prevent severe health risks.
Early Signs of Toxicity:
• Nausea, vomiting, diarrhea
• Drowsiness, tremors, muscle weakness
• Increased thirst, frequent urination, blurred vision
Advanced Signs of Toxicity (Seek Immediate Help):
• Severe tremors, muscle twitching
• Slurred speech, confusion, severe drowsiness
• Seizures, irregular heartbeat, loss of consciousness
Emergency Actions if You Suspect Toxicity:
1. Stop taking lithium immediately
2. Seek Immediate Medical Help: Contact your healthcare provider, call 911, or go to the ER.
3. Inform Clinicians: Share your lithium use and any other medications or supplements.
4. Follow-Up Care: Regular follow-ups will be necessary to adjust dosage and monitor levels.
Lithium FAQ
How can I prevent lithium toxicity?
• Blood Tests: Regular monitoring of lithium levels.
• Hydration: Stay hydrated to reduce toxicity risk.
• Stable Salt Intake: Avoid sudden changes in your salt consumption.
• Symptom Awareness: Watch out for early signs of toxicity (as above).
• Follow Prescriptions: Take lithium exactly as directed.
Is there anything else I can take to protect my kidneys and thyroid proactively?
Some supplements have been studied for protecting the body from lithium’s side effects, but so far the evidence is limited. For example, astaxanthin and N-acetylcysteine have shown kidney-protecting effects in animals taking lithium, but we don’t yet have solid studies in humans. Similarly, zinc and selenium may reduce thyroid problems from lithium in animal studies, but again, this hasn’t been proven in people. At standard doses these supplements are usually safe, but right now their benefit for people on lithium remains unproven.
Before considering taking a supplement, what do I need to know about supplements in general?
In the USA, dietary supplements are not subject to the same rigorous testing and regulatory standards as prescription medications, which can lead to variability in their quality, purity, and efficacy. Additionally, manufacturers are responsible for ensuring safety and making truthful claims without pre-market approval by the FDA, meaning that both consumers and healthcare providers must exercise caution and rely on independent research for guidance. Websites like ConsumerLab.com can be helpful for making an informed choice.
I’m worried about weight gain from lithium.
Lithium is associated with modest weight gain, with genetic factors influencing individual susceptibility. Research shows that most people only gain a small amount, less than one pound. One study found that your genes (the instructions in your body) might affect how much weight you gain on lithium, but these genes don’t seem to change how hungry you feel. If someone does gain a little weight on lithium, things like eating whole foods and getting regular exercise can really help. So overall, lithium might cause a small weight gain, but it's usually not much, and there are ways to manage it.
I’m worried about hair loss from lithium.
Hair loss occurs in approximately 10-19% of patients on long-term lithium therapy, but it generally grows back if treatment is stopped. It is important to remember that regrowth takes time. Management strategies nutritional supplementation (zinc, selenium), and topical minoxidil, though evidence for efficacy in lithium-induced alopecia is limited.
References
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