Lithium (medication)
Lithium salts are mood stabilizers used for bipolar disorder and depression.
Lithium salts are a class of psychiatric medication taken orally, primarily used as mood stabilizers for bipolar disorder and major depressive disorder. They are unique among medications in that they have been proven to reduce the risk of suicide in mood disorders. Common side effects include increased urination, hand shakiness, and increased thirst; serious side effects can involve hypothyroidism, diabetes insipidus, and lithium toxicity. Because the therapeutic dose is close to the toxic level, blood level monitoring is recommended to lower the risk of toxicity. If levels become too high, symptoms such as diarrhea, vomiting, poor coordination, sleepiness, and ringing in the ears may occur. Lithium is teratogenic and can cause birth defects at high doses, especially during the first trimester of pregnancy. Its use while breastfeeding is controversial, with many health authorities advising against it; the American Academy of Pediatrics lists it as contraindicated for pregnancy and lactation, and the U.S. FDA categorizes it as having positive evidence of risk in pregnancy and possible hazardous risk in lactation. The mechanism of action is not known. In the nineteenth century, lithium was used for gout, epilepsy, and cancer. Its use for mental disorders began in the 1870s, when Carl Lange in Denmark and William Alexander Hammond in New York City treated mania with it, based on now-discredited theories involving uric acid. Its modern psychiatric use was re-established in 1948 by John Cade in Australia. Lithium carbonate is on the World Health Organization's List of Essential Medicines and is available as a generic. It appears to be underused in older people and in certain countries, partly due to patients' negative beliefs. For bipolar disorder, lithium is primarily a maintenance drug to stabilize mood and prevent manic episodes, and it is also effective for acute mania within the first week of treatment. Evidence for its superiority over placebo in acute bipolar depression is low-quality, but it is effective for long-term prevention of depressive episodes. It has shown effectiveness in children as young as eight with early-onset bipolar disorder. In schizophrenic disorders, lithium is recommended only after other antipsychotics have failed, as it has limited effectiveness alone. For major depressive disorder, lithium is widely prescribed as an adjunct when an
- field
- Psychiatry
- known_for
- Mood stabilizer for bipolar disorder; suicide prevention in mood disorders
- first_psychiatric_use
- 1870s by Carl Lange and William Alexander Hammond
- WHO_essential_medicine
- Yes (lithium carbonate)
Lore & Background
In the nineteenth century, lithium was used for gout, epilepsy, and cancer. Its use in mental disorders began in the 1870s with Carl Lange in Denmark and William Alexander Hammond in New York City, who treated mania based on now-discredited theories involving uric acid. Lithium is primarily used as a maintenance drug for bipolar disorder to stabilize mood and prevent manic episodes, and it is also effective in acute mania within the first 7 days. It is sometimes used off-label for major depression, schizophrenia, impulse control disorders, and certain childhood psychiatric conditions. Lithium is proven to reduce suicide risk in mood disorders by 87% in randomized double-blind placebo-controlled trials, though some meta-analyses dispute this finding. Common side effects include increased urination, hand shakiness, and increased thirst. Serious side effects include hypothyroidism, diabetes insipidus, and lithium toxicity. Blood level monitoring is recommended; high levels can cause diarrhea, vomiting, poor coordination, sleepiness, and ringing in the ears. Lithium is teratogenic at high doses, especially in the first trimester, and its use during breastfeeding is controversial, with many health authorities advising against it.
Reader's Guide
Lithium remains a cornerstone treatment for bipolar disorder, listed on the World Health Organization's List of Essential Medicines and available as a generic medication. Its significance lies in its unique ability to prevent suicide in mood disorders, a property not shared by other psychotropic drugs. However, its use is limited by a narrow therapeutic index requiring regular serum monitoring of lithium levels, thyroid and kidney function, and risk of toxicity. Lithium appears to be underused in older people and in certain countries, partly due to patients' negative beliefs about the drug. Despite decades of use, its mechanism of action remains unknown, though studies show it partially reverses telomere shortening and increases mitochondrial function in bipolar patients. The drug's legacy includes its role as a mood stabilizer, its efficacy in reducing dementia risk by 50% in bipolar disorder, and its association with lower suicide rates in populations with trace lithium in drinking water.
Did You Know?
- Lithium is unique among medications in that it is proven to prevent suicide in mood disorders such as bipolar disorder and recurrent major depression.
- Lithium reduces the risk of dementia by 50% among people with bipolar disorder.
- The increased presence of trace amounts of lithium in drinking water is correlated with lower overall suicide rates, especially among men.
- Lithium is teratogenic and can cause birth defects at high doses, especially during the first trimester of pregnancy.
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