Saturday, 9 October 2010


Yesterday my Psychiatry consultant told me I needed to know about Lithium. This is a good idea. As a result of my ignorance on the use of Lithium being uncovered I will present what I have researched/copied from a book here.


  • Mode of action is unkown
  • Usually given as lithium carbonate, it is most useful in preventing mania. Needs to be given for 18 months for the benefits to be clear.
  • At therapeutic levels the side effects are fine tremor, metallic taste, dry mouth, thirst, mild polyura, nausea, weight gain and hypothyroidism in 20% of women who take it - this is rarer in men, Renal impairment can occur after prolonged use
  • Above 2.5 mmol/L you get coarse tremor, agitation, twitching, thirst and polyura, At higher levels renal failure, seizure, coma and death. Toxic levels can arise from dehydration or with a low salt diet
  • Before starting perfom an ECG, electrolyte balance, creatinine clearancem TFTs.
  • Measure lithium levels weekly, then every 3 months when stable
  • Test thyroid function and renal function every 6 months to avoid rebound mania
  • Withdraw gradually so that you avoid rebound mania
  • Avoid in patients where adherence will ne an issue and avoid in renal failure and pregnancy. Best not to combine with diuretics, ACE inhibitors etc.

If you would like to contribute to my education and feel I need to know more then please let me know


  1. For what it is worth, I have made a number of postings on Lithium:

    The Cockroach Catcher Blog-Lithium

    Used well, it could have prevented a few high profile suicides. It is cheap,until they use it in car batteries.

  2. IT's also something I've thought about, but the bottom line is to consistently drink plenty of fluids :)

  3. Clinicians are also advised to take a "start low and go slow" approach when starting lithium - Miklowitz 2002

    It is also a prophylactic treatment therefore requires indefinite long term treatment.