What are the reviews on taking lithium (lithium carbonate) for mood stabilization and tolerance development?

From the Guidelines

Lithium is an effective mood stabilizer for conditions like bipolar disorder, but requires careful medical supervision to minimize the risk of relapse and side effects, as evidenced by studies such as 1 and 1.

Key Considerations for Lithium Therapy

• Typical dosing ranges from 600-1200mg daily, divided into multiple doses, with blood levels maintained between 0.6-1.2 mEq/L, as recommended in 1.
• Side effects commonly include tremor, increased thirst, frequent urination, and mild nausea, which often improve with time as tolerance develops, as noted in 1.
• Most patients develop some tolerance to these initial side effects within 2-4 weeks of starting treatment.
• Long-term use requires regular blood tests to monitor lithium levels, kidney function, and thyroid function, as lithium has a narrow therapeutic window, highlighted in 1.

Monitoring and Maintenance

• Baseline laboratory assessment should include complete blood cell counts, thyroid function tests, urinalysis, and other tests as indicated, before initiating lithium therapy, as advised in 1.
• Regular monitoring of lithium levels, renal and thyroid function, and urinalyses should be performed every 3-6 months, as recommended in 1.
• Patients and families should be educated on the early signs and symptoms of mood episodes and potential side effects, to ensure prompt intervention if necessary.

Special Considerations

• Lithium should not be stopped suddenly, as this can trigger mood episodes, emphasizing the importance of gradual discontinuation and close monitoring, as cautioned in 1.
• If side effects become problematic, the doctor may adjust the dose, switch to extended-release formulations, or recommend taking lithium with food to improve tolerance, as suggested in 1.
• Consistent salt and water intake should be maintained while taking lithium, as changes can affect blood levels, highlighting the need for patient education and monitoring, as noted in 1.

From the FDA Drug Label

The ability to tolerate lithium is greater during the acute manic phase and decreases when manic symptoms subside Decreased tolerance to lithium has been reported to ensue from protracted sweating or diarrhea and, if such occur, supplemental fluid and salt should be administered. Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of those episodes which may occur.

The reviews on taking lithium for mood stabilization indicate that lithium tolerance is greater during the acute manic phase but decreases when manic symptoms subside. Tolerance development may be affected by factors such as protracted sweating or diarrhea, which can lead to decreased tolerance. Lithium is effective in mood stabilization for Bipolar Disorder, reducing the frequency and intensity of manic episodes. However, careful monitoring of serum levels and clinical response is necessary to minimize the risk of lithium toxicity 2, 2.

From the Research

Mood Stabilization

• Lithium has been shown to be effective in the treatment of mood disorders, including unipolar depression and bipolar disorder 3.
• It is considered a first-line option for bipolar disorder, especially in prophylaxis and when onset of action is not an imperative 3.
• Lithium has specificity for mood disorders and is arguably the only true mood stabilizer 3.

Tolerance Development

• Long-term lithium therapy can lead to side effects such as renal, gastrointestinal, neurological, thyroid, metabolic, cognitive, dermatological, cardiologic, and sexual issues 4.
• Interstitial nephropathy is a significant negative effect of lithium, occurring mostly after 10-20 years of administration 4.
• However, long-term lithium therapy can also have beneficial side-effects, including anti-suicidal, antiviral, and anti-dementia effects 4.

Dose-Dependent Effects

• The clinical effectiveness of lithium is counterbalanced by its safety and tolerability profile, with a narrow therapeutic index requiring monitoring of lithium levels 5.
• Adequate serum levels should be above 0.6 mEq/L to achieve clinical effectiveness, but increasing evidence suggests that lithium might have clinical and molecular effects at much lower concentrations 5.
• Lower levels of lithium may be sufficient for preventing depressive recurrences in older populations, and microdoses could be effective in decreasing suicide risk, especially in patients with bipolar disorder 5.

Low-Dose Lithium Supplementation

• Low-dose lithium (≤0.5 mM) may have beneficial effects on cardiovascular, musculoskeletal, metabolic, and cognitive function, as well as inflammatory and antioxidant processes of the aging body 6.
• There is evidence that low-dose lithium can exert a similar and sometimes synergistic effect on these systems, and may have potential benefits on the aging process and age-related diseases 6.