What is the preferred treatment between lithium carbonate and Eskalith (lithium carbonate) for an adolescent patient?

Lithium Carbonate and Eskalith Are Identical Medications

Lithium carbonate and Eskalith are the exact same medication—Eskalith is simply a brand name for lithium carbonate. There is no clinical difference between them in terms of efficacy, safety, or appropriateness for adolescent patients 1.

Understanding the Nomenclature

• Lithium carbonate is the generic chemical name for the mood stabilizer used in bipolar disorder 1
• Eskalith is a brand name formulation of lithium carbonate that was historically marketed but is now rarely used, as generic lithium carbonate has become the standard 1
• Both contain the same active ingredient and work through identical mechanisms 1

FDA Approval for Adolescents

• Lithium is the only FDA-approved medication for bipolar disorder in adolescents age 12 and older, making it the gold standard first-line treatment regardless of whether you use the generic or brand name 1
• The American Academy of Child and Adolescent Psychiatry explicitly recommends lithium for both acute mania and maintenance therapy in this age group 1

Clinical Considerations for Adolescent Use

Dosing and Pharmacokinetics

• Adolescents have higher volumes of body water and more active renal glomerular filtration rates than adults, which affects lithium clearance 2
• Target serum levels are 0.8-1.2 mEq/L for acute treatment of mania, with some patients responding at lower concentrations 1, 3
• Starting dose is typically 300 mg three times daily (900 mg/day total) for patients weighing ≥30 kg, or 300 mg twice daily (600 mg/day) for patients <30 kg 1
• There is considerable variability in lithium exposures in young patients, with clearance relating best to fat-free mass rather than age 4

Monitoring Requirements

• Baseline assessment must include: complete blood count, thyroid function tests, urinalysis, BUN, creatinine, serum calcium, and pregnancy test in females 1
• Ongoing monitoring every 3-6 months: lithium levels, renal function, thyroid function, and urinalysis 1, 3
• Lithium accumulates in the thyroid gland at concentrations 3-4 times higher than plasma and can cause goiter or hypothyroidism, requiring thyroid ultrasound at baseline and 6-12 month intervals 5

Unique Benefits in Adolescents

• Lithium reduces suicide attempts 8.6-fold and completed suicides 9-fold, an effect independent of its mood-stabilizing properties—particularly critical in high-risk adolescent populations 1, 6
• Response rates for acute mania in adolescents range from 38-62% 1
• For bipolar depression in adolescents, open-label studies show mean depression scores decreased significantly with a large effect size of 1.7, with 48% response rate and 30% remission rate 7

Common Pitfalls to Avoid

• Never discontinue lithium abruptly—over 90% of noncompliant adolescents relapsed versus 37.5% of compliant patients 1, 3
• Lithium overdoses can be lethal; parents must secure medication and remove access to lethal quantities, with third-party supervision essential in suicidal adolescents 1
• When combined with other psychotropic medications with sedative properties, lithium may increase risk of nocturnal enuresis due to polyuria—monitor for this side effect particularly in younger patients 8
• The developing central nervous system in adolescents is vulnerable to medication effects, requiring close monitoring for side effects including tremor, nausea, headache (74%), and gastrointestinal symptoms 2, 7

Maintenance Therapy Duration

• Continue lithium for at least 12-24 months after mood stabilization; some adolescents require lifelong treatment 1, 3
• Withdrawal of maintenance therapy dramatically increases relapse risk, especially within 6 months following discontinuation 1, 3
• If discontinuation is necessary, taper gradually over 2-4 weeks minimum, never abruptly 1