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Doctors' Answers to "Frequently Asked Questions" - Lithium


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 08/16/2000]
Question: what happens to youo if you take lithium with out having it persribed?
(as in an illigeal drug?

Answer: Lithium can be very toxic and when we use it medically, we check the levels to ensure that it does not get to excessive doses. Lithium toxicity produces confusion disorientation, muscle hyperirritability. In severe toxicity, seizures, coma, death.

[posted 05/18/2000]
Question: I have been taking lithium for bipolar disorder from 1990-1999. I was taken off of the lithium due to elevated liver enzymes - 105 ALT - on last test 5/99. What does this number mean in terms of current liver damage and how can this be corrected?

Answer: Pretty minimal unless there is concurrent rise in your other liver enzymes. Also, there are many things that may cause liver enzyme elevations, lithium is not one or the usual ones, I would suspect another unknown suspect. If your enzymes are now normal, I would not be concerned.

[posted 03/1/2000]
Question: I am Bipolar and have been on Lithium for 3 weeks and
I have developed a loud ringing in my ears. Although
I have read nothing about this being from the Lithium,
someone I know who works in a pharmacy says that this
is a symptom of Lithium Overdose. Is this true?

Answer: Possibly, check your blood level, serum sodium and thyroid levels.

[posted 01/17/2000]
Question: Dear Doctor,

When I take my Synthroid dose (0.112) too close to the first
Lithium dose (300 ea. x 3 per day), I get an effect which
I call the "slamerino". It is truly awful, though it passes
in 40 minutes. The symptoms are dyspnea, chest tightness,
and breathlessness. I must space my drugs carefully to
avoid this. However, I would like some professional advice
on a) why this happens, and b) what the best spacing is.
I don't know much about pharmacodynamics and which drug peaks
when.

Thanks.

Answer: Lithium can cause hypothyroidism and thyroid levels need to be checked. However, replacement(like you are receiving ) fixes this problem. I have never heard of this problem, so I can't give you any sage advice. Both, have long 1/2 lives and "peak" hours after being taken.

[posted 12/1/1999]
Question: I have been taking lithium (eskalith) for over 15 years for manic-depression 450 mg at night and have an average blood test of 0.5 or 0.6 . My question is , I have been "stable" for over 15 hears and am now eighty one (81 years old and can I stop this medecation? There is a conflict with diaretics big time and I don't like the "dry mouth"

Answer: There will still be a risk of reoccurance. Seems like it is working but what was life like before lithium?

[posted 11/23/1999]
Question: I am curently on lithium treatment(1200mg per day)and I have just started to work out and use anabolic steroids (Andriol). It says on the leaflet I got with the lithium that there are contra-indications with steroids, but do not say what they are. I think I will be alright as I only intend to use the steroids for a few weeks, but my girlfrien is woried.

Answer: I have not had any problems with steroids per se. But, I also, don't recall treating a patient with both. Check with the manufacturer,Smith Kline Beecham 800-366-8900.

[posted 11/1/1999]
Question: My sister has been treated for Bi-polar disorder for several years. She was prescribed Depicote and saw positive results "when" she took it (a stubborn girl who would take it only during her low states... in otherwords, whenever she felt like it). Fortunately, when she found out that she was pregnant, she hadn't been taking the medication in about 3 months. It was an unexpected pregnancy, but her doctor had warned her in the past about birth defects and/or the inability to carry a baby to term while taking the drug. Since she's been pregnant, she hasn't been on any form of treatment for Bi-polar Disorder. As a result, along with the hormonal surges that go hand in hand with being pregnant, she's been an emotional mess. It got to the point where she began attempting suicide. She was admitted to a mental hospital. The options given to her were to start taking Lithium or to go through Electroconvulsive Therapy. She is now entering her third Trimester. Less than a week ago, she started taking Lithium Treatment, but I'm afraid of the side effects the drug will have on my unborn Neice or Nephew. But she's opted not to go through ECT in fear that she will never be the same, that ECT could permanently damage her. Is that true, or is ECT a better alternative for her and her unborn child?

Answer: ECT gets a bad rap mainly from Hollywood, it does not seem to have permanent damage unless administered incorrectly or if one suffers hypoxia during it. I would not do ECT while pregnant, and I think Lithium is a better choice. There will need to be thyroid functions done on the child, but otherwise seems to be little fetal risk.

[posted 11/18/1999]
Question: My six year old daughter has been having behavior problems since the age of 2. She was on dextrostat 5mg. 2 times a day and tolerated it very well. A psychiatrist has diagnosed her as being mildly manic and wishes to prescribe lithium. Is she too young to be on lithium? Will it affect her as an adult?

Thank you.

Answer: She is not too young, but ensure she does not have hyperactivity and need Ritalin. This would be more common. If there is a family history of mania/depressive illness he/she may be correct. Hyperactivity would be a lot more common at this age and will not respond to the lithium. Lithium has little long term side effects except it does occasionally shut down the thyroid and needs ongoing monitoring. There are reports of renal damage but, most think that if the levels are followed this is minimal.

[posted 11/13/1999]
Question: started lithium 900mg a day. First follow-up/ lab test is a week away.
Should I still be taking the Ritalin??
Have researched Lithium Carbonate in the PDR.. mentioned Blood levels
taken hours after first dose, and every few hours the first few weeks.
I'm concerned with the lab not being for a week... second lab for another week... then every 4 months after that.
Is there reason to worry or be concerned??

Answer: This would be about the right time to check lithium. I'm not sure what they are referring to with the lithium in terms of early testing, quite a waste of time. Pretty standard, also ensure your serum sodium and Thyroid function is tested occasionally.

Lithium & Memory Loss [posted 12/01/98]
Question: I have been taking Effexor 225mg for about 3 months, and have found it very helpful in treating my severe depression. Recently, however, I felt as though it was becoming less effective. My physician has prescribed 60mg of Lithium once a day to see if this will increase the effectiveness  of the Effexor. Since I began taking the Lithium (3 days ago) I have experienced difficulty sleeping - is this common when the two drugs are used together? There doesn't seem to be much information available about using the two together. I exercise frequently, and understand the necessity of keeping  my fluid intake high. Are there any other precautions I should be taking? Thanks.

Answer: Lithium wouldn't be expected to change your sleep patterns and Effexor shouldn't change much with the Lithium. I would check your thyroid levels, sometimes affected by lithium.

Lithium & Memory Loss [posted 10/6/98]
Question: Do you have any information about the incidence of memory loss with Lithium intake and the causes thereof. I do not see it listed as a side effect but it is a frequent complaint Of individuals taking lithium

Answer: No.

Migraine Headaches and Lithium [posted 8/10/98]
Question: A neurologist I have seen twice prescribed Lithonate for headaches. He said I have migraines. They wake me up from a sound sleep. I never know when one will start, but I do not have the flashes of light, etc. Just headaches day after day. I read that Lithium can cause myasthenia gravis so I quit taking the drug. I am not manic depressive nor am I overly depressed. Why would a physician prescribe a drug that has such devastating side effects? I am 69 years old, very active, both mentally and physically. I quit the medicine cold when I read about this side effect.

Answer: Lithium is used, but is not common or popular for the reasons you note as well as its ability to affect the thyroid gland and sodium metabolism. However, in refractory patients who are incapacitated by migraines, lithium can be useful. Drug levels need to be checked closely as well as serum thyroid functions and serum sodium. Limited use in migraines, but occasionally very effective.

Lithium and Pregnancy [posted 7/31/98]
Question: My friend is 22 years old and was just diagnosed as Bipolar. She is now on Lithium, and desperately wants to get married and have children. Will she ever be able to have children while she is on Lithium?

Answer: Yes.

Lithium
Question: I have been diagnosed as a Manic-Depressive over three years ago. It took me some time to accept it and now, despite my goodwill, I'm facing the fact that I cannot surmount that state without any medication. I will be starting to take Lithium. I would appreciate it if you could give me some information about this medication.

Answer: Lithium has been used for about 25 years for the treatment of mania. Recently, it has received some research in its ability to prevent depression as well. However, approved use is currently for preventing manic episodes. Lithium is fairly rapidly and easily absorbed and is usually absorbed within 7-8 hours. Slow release lithium products are available on the market. However, most patients will take their lithium 2-3 times a day to keep adequate blood levels. Blood levels are checked on a regular basis to ensure that the lithium is in a therapeutic range. That is not too high or too low. High levels can produce vomiting, diarrhea, coordination problems, abdominal pain, sedation(to coma) and seizures. Occasional patients will have cardiac irregularities. Lithium can affect serum sodium and thyroid levels and these must be checked closely. It should be used with extreme caution-or not at all-with diuretics. Any basic medical textbook (Harrison’s' Principles of Internal Medicine for example) will have a longer discussion.

Lithium carbonate
Question: I have the bipolar disorder and was just recently put on lithium. After about 3 weeks the lithium seemed to "kick in", and I felt really good. I was diagnosed with hypothyroid during a physical and placed on Synthroid. I was told by my psychiatrist that I had to fast before and go off all drugs for the blood test. I, thinking nothing of it, decided to stay off all day. By 2 o'clock I started to cry for no reason. I think it was directly connected to lithium. Was the lithium making that immediate response? It sounds scary especially since I tend to be anorexic/bulimic and the doctor said it affects some people that way - putting on extra weight. I'll have to starve to stay thin; I need to lose 20 lbs. as it is! What is your suggestion to counteract this?

Answer: I wouldn’t recommend stopping all drugs prior to checking a level. This seems counterintuitive. Taking the drug at your regular interval seems to make much more sense.

Lithium
Question: I suffer from depression and diagnosis is Bipolar. I am currently taking 1200 mg of lithium and I would like information about the side effects of this drug and if dribble excess is one of its side effects.

Answer: Lithium carbonate has several side effects. They include vomiting diarrhea, coma, ataxia, seizures, confusion (especially with high or toxic doses), cardiac irregularities, low blood pressure, nausea, diarrhea, and sleepiness (can occur without toxic levels). Some patients develop severe polydipsia and polyuria (excess drinking and urination). Lithium levels must be followed closely and are very susceptible to change with dehydration, diuretics or anything that changes sodium balance.

Lithium Carbonate
Question: I have recently started taking lithium and now I am not able to keep an erection. Is this from the medication, and is there anything I can do about this?

Answer: Impotence is a listed side effect of lithium, although not common in my experience. I'd discuss this with your physician and decide whether a drug holiday might he in order to see if the erections return. If so, lithium is the culprit. Sometimes skipping a drug for 1-2 days will restore potency once the cause is established. Also, if the erections do not return a further workup is in order. This should include thyroid functions (since lithium can cause hypothyroidism), prolactin levels, and testosterone levels.

Lithium
Question: I am a 23 year old woman clinically diagnosed with severe O.C.D. and depression. I am currently taking 40 mg of prozac, 600 mg of lithium, and 0.1 mg of synthroid (because I have hypothyroidism). My doctor has told me not to drink alcohol while taking the medication, however, I have been and have not experienced any unusual side effects. At my next appointment I mentioned to her that I had 5 beers the night before and she nearly fell off her seat. She told me that that is lethal and that I cannot drink any alcohol at all but if I need a drink limit it to only 1 drink per week at most. She went on to say that drinking is not a problem with the synthroid or prozac, but the lithium. I would like to know if this is true because when I purchase the lithium at the pharmacy it does not say anywhere on the bottle or on the leaflet that mixing alcohol and lithium is lethal. Also, how long are patients generally on this medication in combination with prozac?

Answer: No problem that I am aware of. There is an effect on lithium to increase sodium clearance and the diuretic effect of alcohol must be watched to ensure that your sodium level does not drop. For practical purposes small doses with replacement of the urinary output with water would work.

Lithium Carbonate
Question: I have a sixteen year old nephew. He was on a high dosage of Ritalin until he was about 12 years old. About that time (may have been some overlap) he started taking 300 mg of Lithium Carbonate. He took two in morning and one in evening. He is developmentally young and has had many social and learning problems. He was molested by a stranger when he was 11. I have reason to suspect abuse in his home. His mother is also on behavior related medication but I do not know what specifically. His step father is a master manipulator. Is it possible he may be on this drug unnecessarily? Why is this being prescribed? I was told by the family that he was diagnosed as schizophrenic at eleven years old.

Answer: Lithium is a prescription drug and would not be prescribed unless the treating physician was reasonably sure the patient suffered from manic-depressive disorder or possibly depression. It is not given for the treatment of schizophrenia. If you have the concerns that you do I would refer you to the child welfare branch of your local state government.

Misuse of lithium
Question: I would very much like it if you would tell me as much information about the use of lithium as a stimulant. I know nothing about drugs as a whole. However, someone who is close to me is using the stuff while getting high on Weed. I am very concerned. The more information can you give me to help me to understand this drug, the better.

Answer: Lithium is a very complex drug which is mainly used in the suppression of manic-depressive disorders. In general, it is thought to suppress the manic episodes, although there is a school of thought which says that it also suppresses depression. Lithium competes with sodium for renal excretion and should be used with caution with any diuretic. It must be regulated very closely due to the potential for toxicity in higher doses. Generally, it is not used as a stimulant in any area of medicine.

Side effects of lithium
Question: I need to find out about the side effects of Lithium. My dosage (900 mg) is causing diarrhea and is complicating my life. Is this physical response normal and/or what can be done or taken that may eliminate this terrible inconvenience?

Answer:Lithium carbonate is normally used in manic depressive disease to suppress or prevent the mania. Expected side effects include a fine tremor, increased thirst and increased urination. Diarrhea and vomiting as well as weakness and lack of coordination are usually signs of toxicity rather than "normal" side effects. Lithium carbonate needs to be followed closely with serum levels. Long term use necessitates following of blood electrolyte and thyroid levels-all of which can be altered with lithium carbonate. The side effects you are describing should be reported to your physician for correlation with serum levels of lithium.

Behavior on Lithium
Question: A close friend of mine has recently begun taking lithium to combat some mental problems he is having. Unfortunately, I don't have to many details on his problems, but was wondering about the effectiveness of lithium in this case? I was also concerned of his current condition, because of his current behavior on the drug. He is currently very, very, slow and very unresponsive. Basically, any info on this would be helpful, especially whether, in your opinion, the drug works. Also, how long do patients usually stay on the drug? I personally question it's use in this case(It's making him a vegetable).

Answer:Lithium carbonate is a drug used to treat the manic side of manic-depressive disorder. It is preventive in nature and will not work during an acute spell of mania. It is occasionally used by psychiatrists for the depressive aspect of this disease-this is more controversial. Side effects of this drug are usually related to the blood level. If a patient is very groggy, his levels are usually high. This drug can interact with several other drugs to cause high or low levels. High levels can be lethal. Other causes of "showiness" could be hypothyroidism which can be induced by lithium. Patients on lithium should have their thyroid levels checked from time to time.



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