When was lithium first used in medicine?
Many mineral springs contain lithium, among other elements, and some of them, such as Mineral Wells in Texas, have age-old reputations as “crazy waters ... The Schou article had a large impact and awakened the possibility of lithium treatment for an illness that previously had been governed mainly with barbiturates (but was in fact highly ...
Can lithium be used to treat bipolar disorder in children?
Lithium has been approved for the acute and maintenance treatment of mixed and manic episodes of BD I in children and adolescents (age from 7 to 17 years) by the FDA. The effectiveness of lithium in paediatric patients has been demonstrated by …
What is a normal lithium level for a 79 year old?
once daily dose - at 12 hours, 0.7 to 1.0 mmol/l; at 24 hours, 0.4 to 0.8 mmol/l. serum lithium levels should be checked 1 week after starting and 1 week after every dose change, and until the levels are stable. The aim should be to maintain serum lithium levels between 0.6 and 0.8 mmol per litre in people being prescribed it for the first time ...
When did lithium become available to treat mania?
Apr 05, 2022 · Not recommended for children aged less than 12. Lithium use may cause an unmasking of Brugada syndrome (a heart disorder characterized by abnormal ECG findings and a risk of sudden death). The range of effects of lithium in pregnancy has not been fully determined so experts recommend women avoid lithium, particularly in the first trimester.
Can a 14 year old take lithium?
Can a 7 year old take lithium?
Can a 15 year old take lithium?
Is lithium first-line treatment for bipolar disorder?
What is the safest mood stabilizer for Children?
- Lithium (Lithobid) There is limited research into this area, but findings show that lithium is safe and may be effective in treating the symptoms of bipolar disorder in children and adolescents.
- Carbamazepine (Carbatrol, Equetro) ...
- Sodium valproate (Depakote)
Is my 5 year old bipolar?
Can elderly take lithium?
What is the best mood stabilizer for anxiety?
Is lithium good for anxiety?
Does lithium reduce life expectancy?
What is a good mood stabilizer for bipolar?
What is the newest medication for bipolar?
Is lithium a twice daily BD?
Therefore, Landersdorfer et al. ( 56) recommend a twice-daily dosing of lithium to achieve acceptable blood concentrations. Data are missing for once-daily dosing of lithium in paediatric BD and is thus not recommended.
What is lithium used for?
Lithium treatment aims at the prevention of relapses and is used in the treatment of acute episodes, such as mania, depression, and specific subtypes , such as mood episodes with mixed features or rapid cycling (RC) (see below).
Is lithium good for bipolar?
Lithium has been the treatment of choice for patients with bipolar disorder (BD) for nearly 70 years. It is recommended by all relevant guidelines as a first-line treatment for maintenance therapy. In this review, we outline the current state of evidence for lithium in the treatment of BD over the lifespan.
What is bipolar disorder?
Bipolar disorder (BD) is an episodic illness with a very heterogeneous clinical course. It usually presents as a severe, chronic, and disabling condition characterized by mood alterations between euthymia, major depression, and (hypo-)mania. The estimated lifetime prevalence ranges from 0.6% to 2.4% worldwide ( 1, 2 ). BD is usually a lifelong disease, hence requiring lifelong treatment strategies. One of the major pharmacological agents in the treatment of BD is lithium. It remains the gold standard in preventing recurrences in BD I (mania and depressive episodes) and BD II (hypomania and depressive episodes) and is effective in the treatment of mania. Additionally, the proposed anti-suicide effect of lithium is unique and potentially of high relevance in the treatment of BD over the lifespan, as patients with BD suffer from high suicide rates ( 3 ). Over the last decades, other substances such as second generation antipsychotics (SGA) and anticonvulsants have been prescribed more frequently and there has been a tendency to avoid lithium in the treatment of BD. Reasons may be the overestimation of potential side effects as compared to other substances by professionals and patients alike, despite the highly problematic metabolic profile of antipsychotics (e.g., Olanzapine), particularly over the lifespan ( 4 ).
Is mania a part of BD?
While manic episodes are often the most impressive part of BD, their duration is usually shorter compared to that of other disease phases in both BD-I and BD-II. A number of pharmacological agents have been investigated and have proven their efficacy in the treatment of mania, including lithium ( 17 ).
What is BD in psychology?
BD, especially in the lifelong course, is typically characterized by recurring mood episodes of opposite polarity. However, patients may also experience episodes in which depressive and manic symptoms co-occur. These phases were traditionally called mixed states or mixed episodes. The DSM-5 substituted these terms by the so-called “mixed specifier”, which indicates the presence of mixed symptoms in either (hypo-)manic or depressive episodes ( 33 ). Patients with mixed features in the course of their illness have a considerably higher risk to commit suicide and higher rates of (psychiatric) comorbidities (e.g., anxiety disorders, substance dependence and personality disorders). They suffer from high rates of relapses and experience a larger number of new episodes compared to BD patients without mixed symptoms ( 34 ).
Is lithium more effective than valproate?
In patients with a manic episode and additional depressive symptoms, lithium was found to be less effective than valproate ( 36 ). Studies investigating the effectiveness of lithium in the maintenance therapy found it to be less effective in patients with mixed symptoms than in patients with “pure” mania.
Is lithium a maintenance drug?
Lithium is primarily used as a maintenance drug in the treatment of bipolar disorder to stabilize mood and prevent manic episodes, but it may also be helpful in the acute treatment of manic episodes. Lithium carbonate treatment was previously considered to be unsuitable for children; however, more recent studies show its effectiveness for treatment of early-onset bipolar disorder in children as young as eight. The required dosage is slightly less than the toxic level (representing a low therapeutic index ), requiring close monitoring of blood levels of lithium carbonate during treatment. A limited amount of evidence suggests lithium carbonate may contribute to treatment of substance use disorders for some people with bipolar disorder.
Can lithium be used alone?
Lithium is recommended for the treatment of schizophrenic disorders only after other antipsychotics have failed; it has limited effectiveness when used alone. The results of different clinical studies of the efficacy of combining lithium with antipsychotic therapy for treating schizophrenic disorders have varied.
Is lithium safe to use while breastfeeding?
If levels become too high, diarrhea, vomiting, poor coordination, sleepiness, and ringing in the ears may occur. If used during pregnancy, lithium can cause problems in the baby. It appears to be safe to use while breastfeeding.
What is lithium used for?
Medical uses. A bottle of lithium capsules. Lithium is used primarily for bipolar disorder. It is sometimes used when other treatments are not effective in a number of other conditions, including major depression, schizophrenia, disorders of impulse control, and some psychiatric disorders in children.
Is lithium good for bipolar?
Bipolar disorder. Lithium is primarily used as a maintenance drug in the treatment of bipolar disorder to stabilize mood and prevent manic episodes, but it may also be helpful in the acute treatment of manic episodes.
Is lithium carbonate safe for children?
Lithium carbonate treatment was previously considered to be unsuitable for children; however, more recent studies show its effectiveness for treatment of early-onset bipolar disorder in children as young as eight.
Does lithium cause depression?
The rate of hypothyroidism is around six times higher in people who take lithium. Low thyroid hormone levels in turn increase the likelihood of developing depression. People taking lithium thus should routinely be assessed for hypothyroidism and treated with synthetic thyroxine if necessary.
What to do if you miss a dose of a sulfate sulfate?
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
How to store a med?
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you do not use.
Can you take IBM Micromedex more often?
Drug information provided by: IBM Micromedex. Take this medicine exactly as directed by your doctor. Do not take more or less of it, do not take it more or less often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.
How long does it take for lithium to be absorbed?
Response and effectiveness. Lithium is completely absorbed in the gastrointestinal tract with peak levels occurring 0.25 to 3 hours after oral administration of immediate-release preparation s and two to six hours after sustained-release preparations.
How often should you monitor lithium levels?
Monitoring is required and should be done twice weekly during therapy initiation and then every two months long-term.
What is lithium used for?
Lithium may be used to treat mania associated with bipolar disorder. Experts are not sure exactly how lithium works but believe it alters sodium transport in nerve and muscle cells which adjusts the metabolism of neurotransmitters within the cell. Lithium is an element found naturally in the environment and our bodies.
How does lithium work?
Experts are not sure exactly how lithium works but believe it alters sodium transport in nerve and muscle cells which adjusts the metabolism of neurotransmitters within the cell. Lithium is an element found naturally in the environment and our bodies. Lithium belongs to the class of medicines known as antimanic agents.
What are the side effects of lithium?
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Fine hand tremor, frequent urination, and mild thirst commonly occur during lithium initiation. Sometimes these effects may persist throughout treatment.
Does lithium cause nausea?
Diarrhea, vomiting, drowsiness, muscular weakness, loss of appetite, and coordination difficulties may be an early sign of lithium toxicity.
What are the symptoms of lithium toxicity?
Diarrhea, vomiting, drowsiness, muscular weakness, loss of appetite, and coordination difficulties may be an early sign of lithium toxicity. Dizziness, blurred vision, ringing in the ears and excessive production of dilute urine may occur with higher (toxic) lithium levels. Seek urgent medical advice.
Abstract
Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before ( N = 79) or after ( N = 31) the age of 65 years.
Background
Reviews published over the last two decades continue to recommend lithium treatment in elderly patients with bipolar disorder (Young et al. 2004; Aziz et al. 2006; Shulman 2010 ).
Methods
Out of the 350 patients treated with lithium who had attended the Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria, Cagliari, at least once between January and August 2010, we selected those born in 1945 or earlier ( N = 110; 80 women, 30 men).
Results
At the start of the study, median serum concentration of lithium in the 110 patients was 0.55 mmol/l. Patients were taking regularly the following medications: N = 80 (73%) benzodiazepines, N = 57 (52%) ACE inhibitors, sartans, and/or thiazides, N = 21 (19%) oral hypoglycemic agents or insulin, and N = 34 (31%) hypolipidemic agents.
Discussion
This observational study provides a snapshot of current prescription attitudes regarding lithium treatment in the elderly at our center.
Conclusions
This observational study provides some clues regarding lithium treatment in the elderly. As comorbidity and polypharmacy may increase the risk of adverse events and drug interactions, median lithium serum concentration in this cohort was lower than the therapeutic range indicated for younger adults.
Author information
Unit of Clinical Pharmacology, Azienda Ospedaliero-Universitaria di Cagliari, “San Giovanni di Dio” Hospital, Via Ospedale 54, 09124, Cagliari, Italy
Fact 1: Lithium Is Most Commonly Used to Treat Bipolar Disorder
Lithium is considered a mood stabilizer — a group of medications used to treat the highs (mania) and lows (depression) of bipolar disorder. It’s approved by the U.S. Food and Drug Administration (FDA) for two important uses related to bipolar disorder.
Myth 1: Lithium Works Instantly
Lithium does not work instantly. This treatment needs to be started slowly, and there is a specific level of this medication in the blood that needs to be reached.
Fact 2: You Need to Get Lab Tests Before Starting and While Taking Lithium
Lab tests before and while a person is taking lithium are important for several reasons. This medication can affect your kidneys and thyroid, so your doctor needs to know how well they’re functioning before starting treatment. Your doctor will also monitor you for changes in kidney and thyroid function while you're on this treatment.
Myth 2: Lithium Is Stronger and More Dangerous Than Other Psychiatric Medications
When I counsel people on lithium, I get very different responses each time. Some people feel more comfortable with lithium than other medications because it’s a naturally occurring element, while other people have heard about experiences like Spears’s and worry that it’s too strong for them.
Fact 3: Lithium Can Affect How Awake and Alert You Feel
One thing Spears mentioned disliking about lithium during her June 2021 hearing was that it made her feel “drunk.” While it is not typical to feel drunk while taking lithium, it can affect how alert and awake you feel. Even at the correct dose, you can feel somewhat drowsy and less mentally sharp when taking lithium.
Myth 3: We Know Exactly How Lithium Works
Lithium is complex, and experts don’t know exactly how it works in the body.
Fact 4: You Can Safely Take Lithium Long Term
During her June 2021 hearing, Spears mentioned that lithium should not be used for more than five months — this is not true.
Usual Adult Dose for Mania
Acute Control: 1800 mg/day#N#-Regular release formulations: 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 900 mg orally 2 times a day#N#Long-term Control: 900 to 1200 mg/day#N#-Regular release formulations: 300 to 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 600 mg orally 2 times a day#N#Comments:#N#-Regular release formulations should be given in the morning, afternoon, and nighttime (3 times a day dosing) or in the morning and at nighttime (2 times a day dosing).#N#-Extended release formulations should be given in the morning and at nighttime.#N#-Dosing must be individualized according to serum levels and the response to treatment.#N#-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).#N#Uses:#N#-Treatment of manic episodes of bipolar disorder#N#-Maintenance treatment for individuals with bipolar disorder.
Usual Adult Dose for Bipolar Disorder
Acute Control: 1800 mg/day#N#-Regular release formulations: 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 900 mg orally 2 times a day#N#Long-term Control: 900 to 1200 mg/day#N#-Regular release formulations: 300 to 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 600 mg orally 2 times a day#N#Comments:#N#-Regular release formulations should be given in the morning, afternoon, and nighttime (3 times a day dosing) or in the morning and at nighttime (2 times a day dosing).#N#-Extended release formulations should be given in the morning and at nighttime.#N#-Dosing must be individualized according to serum levels and the response to treatment.#N#-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).#N#Uses:#N#-Treatment of manic episodes of bipolar disorder#N#-Maintenance treatment for individuals with bipolar disorder.
Usual Pediatric Dose for Mania
12 years and older:#N#Acute Control: 1800 mg/day#N#-Regular release formulations: 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 900 mg orally 2 times a day#N#Long-term Control: 900 to 1200 mg/day#N#-Regular release formulations: 300 to 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 600 mg orally 2 times a day#N#Comments:#N#-Regular release formulations should be given in the morning, afternoon, and nighttime (3 times a day dosing) or in the morning and at nighttime (2 times a day dosing).#N#-Extended release formulations should be given in the morning and at nighttime.#N#-Dosing must be individualized according to serum levels and the response to treatment.#N#-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).#N#-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.#N#Uses:#N#-Treatment of manic episodes of bipolar disorder#N#-Maintenance treatment for individuals with bipolar disorder.
Usual Pediatric Dose for Bipolar Disorder
12 years and older:#N#Acute Control: 1800 mg/day#N#-Regular release formulations: 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 900 mg orally 2 times a day#N#Long-term Control: 900 to 1200 mg/day#N#-Regular release formulations: 300 to 600 mg orally 2 to 3 times a day#N#-Extended release formulations: 600 mg orally 2 times a day#N#Comments:#N#-Regular release formulations should be given in the morning, afternoon, and nighttime (3 times a day dosing) or in the morning and at nighttime (2 times a day dosing).#N#-Extended release formulations should be given in the morning and at nighttime.#N#-Dosing must be individualized according to serum levels and the response to treatment.#N#-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).#N#-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.#N#Uses:#N#-Treatment of manic episodes of bipolar disorder#N#-Maintenance treatment for individuals with bipolar disorder.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl 30 to 89 mL/min): Begin with lower doses and titrate slowly; closely monitor serum concentrations and signs/symptoms of lithium toxicity.#N#Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended.#N#Any progressive/sudden change in renal function (even within the normal range): Reevaluate treatment..
Dose Adjustments
Therapeutic drug monitoring/range:#N#-Acute episodes: 0.8 to 1.5 mEq/L, not to exceed 2 mEq/L#N#-Long-term control: 0.6 to 1.2 mEq/L#N#-Patients who are abnormally sensitive may exhibit toxicity at concentrations of 1 to 1.5 mEq/L.#N#Serum levels should be drawn immediately prior to the next dose (e.g., 8 to 12 hours after the previous dose).#N#-Acute episodes: Levels should be determined 2 times a week, and continued until the patient is stable.#N#-Long-term control: Levels should be assessed regularly.#N#-Serum levels should be monitored after any change in dose, concomitant medication, marked increase/decrease in routine physical activity, and/or in the event of concomitant disease.#N#Elderly patients: Begin at the lower end of the dosing range#N#Patients with significant cardiovascular disease, debilitation, dehydration, and/or sodium depletion and those receiving drugs that could affect kidney function: Begin with lower doses and titrate slowly; closely monitor serum concentrations and signs/symptoms of lithium toxicity..
Precautions
US BOXED WARNINGS:#N#LITHIUM TOXICITY:#N#-Lithium toxicity is closely related to serum lithium concentrations, and can occur at doses close to therapeutic concentrations.#N#-Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.#N#NARROW THERAPEUTIC INDEX:#N#-This drug should be considered a narrow therapeutic index (NTI) drug as small differences in dose or blood concentrations may lead to serious therapeutic failures or adverse drug reactions.#N#Recommendations:#N#-Generic substitution should be done cautiously, if at all, as current bioequivalence standards are generally insufficient for NTI drugs.#N#-Additional and/or more frequent monitoring should be done to ensure receipt of an effective dose while avoiding unnecessary toxicities.#N#Safety and efficacy have not been established in patients younger than 12 years.#N#Consult WARNINGS section for additional precautions..
Medical Uses
Adverse Effects
- Sources for the following lists. Very Common (> 10% incidence) adverse effects of lithium include 1. Confusion 2. Constipation(usually transient, but can persist in some) 3. Decreased memory 4. Diarrhea(usually transient, but can persist in some) 5. Dry mouth 6. EKGchanges — usually benign changes in T waves. 7. Hand tremor(usually transient, but can persist in some) with an incidenc…
Interactions
- Lithium plasma concentrations are known to be increased with concurrent use of diuretics—especially loop diuretics (such as furosemide) and thiazides—and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Lithium concentrations can also be increased with concurrent use of ACE inhibitors such as captopril, enalapril, and lisinopril. Lithium is primar…
Overdose
- Lithium toxicity, which is also called lithium overdose and lithium poisoning, is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactionsin the body. In acute toxicity, people have primarily gastrointestinal symptoms such as vomiting and diarrhea, which may resu…
Mechanism of Action
- The specific biochemical mechanism of lithium action in stabilizing mood is unknown. Upon ingestion, lithium becomes widely distributed in the central nervous system and interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotoninsynthesis. Unlike many other psychoactive drugs, Li+ typically produces no obvious ps…
History
- Lithium was first used in the 19th century as a treatment for gout after scientists discovered that, at least in the laboratory, lithium could dissolve uric acid crystals isolated from the kidneys. The levels of lithium needed to dissolve urate in the body, however, were toxic. Because of prevalent theories linking excess uric acid to a range of disorders, including depressive and manic disorde…
Salts and Product Names
- Many different lithium salts can be used as medication, including lithium carbonate, lithium acetate, lithium sulfate, lithium citrate, lithium orotate, and lithium gluconate. Lithium carbonate (Li2CO3), sold under several trade names, is the most commonly prescribed, while lithium citrate (Li3C6H5O7) is also used in conventional pharmacological treatments. Lithium orotate (C5H3Li…
Research
- Tentative evidence in Alzheimer's disease showed that lithium may slow progression. It has been studied for its potential use in the treatment of amyotrophic lateral sclerosis(ALS), but a study showed lithium had no effect on ALS outcomes.
See Also
Further Reading
- Mota de Freitas, Duarte; Leverson, Brian D.; Goossens, Jesse L. (2016). "Chapter 15. Lithium in Medicine: Mechanisms of Action". In Astrid, Sigel; Helmut, Sigel; Roland K.O., Sigel (eds.). The Alka...