From the Research
The recommended dose of lithium for suicidal patients is typically 600-1200 mg per day, divided into multiple doses, with the goal of achieving a serum level between 0.6 and 1.2 mEq/L, as supported by the most recent study 1.
Key Considerations
- Treatment should begin with a lower dose (300 mg twice daily) and gradually increase while monitoring blood levels, as lithium requires careful monitoring of kidney and thyroid function, as well as electrolyte levels, particularly sodium 2.
- Regular blood tests are essential, initially weekly until stable levels are achieved, then every 3-6 months, to minimize the risks associated with lithium use 1.
- Patients should maintain consistent salt and fluid intake, avoid NSAIDs and diuretics when possible, and be aware of side effects like tremor, increased thirst, and frequent urination, as these can impact lithium levels and overall health 3.
- Lithium works by stabilizing mood through multiple mechanisms, including modulation of neurotransmitters and neuroprotective effects, and its anti-suicidal properties appear somewhat independent of its mood-stabilizing effects, making it particularly valuable for suicide prevention in various psychiatric conditions, especially bipolar disorder 4.
Important Factors
- The presence of comorbid conditions, acuity of suicide risk, and history of self-directed violence should be considered when deciding to use lithium for suicide prevention, as these factors can impact the risk-benefit analysis 1.
- An individualized risk-benefit analysis must take into account the potential risks associated with lithium use, as well as alternative treatment options, to ensure that prescribing is done in a patient-centered fashion that mitigates risks 1.
- The therapeutic relationship and treatment adherence should also be considered, as these can impact the effectiveness of lithium treatment and overall patient outcomes 2.