From the Research
Lithium can be considered as an adjunctive treatment for emotionally unstable personality disorder, but it is not typically a first-line treatment. The use of lithium in this context is based on its mood-stabilizing properties, which may help reduce impulsivity, aggression, and mood instability in some patients with emotionally unstable personality disorder 1. When prescribed, lithium is usually started at a low dose (300mg once or twice daily) and gradually increased while monitoring blood levels, aiming for a therapeutic range of 0.6-1.2 mmol/L 2.
Key Considerations
- Treatment requires regular blood tests to check lithium levels and monitor kidney and thyroid function 3.
- Common side effects include tremor, increased thirst, frequent urination, and weight gain 2.
- More serious toxicity can occur at higher blood levels, emphasizing the need for careful monitoring 4.
- Lithium works by stabilizing neural membranes and affecting neurotransmitter systems that regulate mood and impulse control 1.
Primary Treatment Approach
However, psychotherapy approaches like dialectical behavior therapy (DBT) are considered more effective primary treatments for emotionally unstable personality disorder, with medications like lithium typically serving as adjunctive therapy for specific symptoms rather than as standalone treatment 5. The most recent and highest quality study on lithium's use in psychiatric disorders highlights its efficacy and safety profile, particularly in the context of bipolar disorder, which shares some symptomatology with emotionally unstable personality disorder 5.
Clinical Decision Making
In clinical practice, the decision to use lithium in emotionally unstable personality disorder should be made on a case-by-case basis, considering the patient's specific symptoms, history, and response to other treatments. Given the potential benefits and risks, lithium should be used under close supervision, with regular monitoring of its levels and the patient's clinical status. This approach ensures that the treatment is both effective and safe, minimizing the risk of adverse effects while maximizing the therapeutic benefits for patients with emotionally unstable personality disorder.