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medication/ mood stabilizers / lithium

Mood stabilizers: lithium

Measure lithium levels ​

Lithiemia is measured on an empty stomach, without water intake


  • Twelve hours after taking the last dose

  • During treatment in times of crisis: every week

  • During maintenance treatment: monthly at first, then spaced when stable

  • When there are symptoms of intoxication (diarrhoea, nausea, vomiting, increased fatigue, mental sluggishness, severe tremors

  • or lack of coordination of movements, etc.)

  • When lithium doses were changed

  • When a physical illness occurs, especially when it causes fever, diarrhea or vomiting

  • When there is an increase in perspiration caused, among other things, by prolonged heat

  • or physical activity

  • When the person starts taking drugs that increase the level of lithium

  • When there is a change in salt intake or diet

  • When there is a deficiency of the thyroid gland

  • On admission to hospital

  • To verify treatment adherence


Physical health issues

  • After cancer chemotherapy or radiotherapy, as they stimulate the production of white blood cells in the blood

  • Some forms of hyperthyroidism

  • Some forms of migraine

  • Inappropriate syndrome of antidiuretic hormone secretion


Mental health problems

  • Bipolar disorder, manic or depressive phase

  • Prevention of relapses of bipolar disease

  • Unipolar depression, in addition to an antidepressant

  • Aggressive or explosive behavior

Contraindications ​


Physical health issues

  • Renal failure

  • Urinary retention

  • Dehydration

  • Serious infection

  • Psoriasis

  • Certain cardiac arrhythmias

  • Poor functioning of the thyroid  (hypothyroidism)

  • Organic brain damage

  • Parkinson disease

  • The need to take diuretics, anti-inflammatories or neuromuscular blockers



  • Lower doses than those used for adults

  • Signs of poisoning should be watched carefully, especially if the user is on a low-salt diet or  if he takes diuretics

  • With antipsychotics, this can cause  symptoms of confusion, memory loss,  disorientation, fear and restlessness

  • Lithium toxicity often manifests  faster in older people with dementia and parkinsonism


Pregnancy and breast feeding

Abstain during the first trimester and during  breastfeeding as well as a few days before and during childbirth


For kids

The efficacy and safety of lithium have not been established



Inability presented by the person to comply with regular blood tests

Drugs interactions ​


Psychiatric drugs (add to side effects )

  • Antidepressants

  • Certain anticonvulsants

  • Some antiparkinsonians

  • Increases carbamazepine toxicity  (Tegretol)

  • Antipsychotics

  • Benzodiazepines


Other drugs (dangerous because they raise the level of lithium in the blood)

  • Nonsteroidal anti-inflammatory drugs are the main cause of poisoning, as some are available over the counter from the pharmacist

- Ibuprofen (Advil, Motrin)

- Indomethacin (Indicid)

- Naproxen (Naprosyn)

- Sulindac (Clinoril)

- Celecoxib (Celebrex)

- Acetylsalicylic acid (Aspirin)

- Diclofenac (Voltaren)


  • Diuretics

- Hydrochlorothiazide (Hydrodiuril)

- Furosemide (Lasix)

- Triamterene-HCTZ (Dyazide)

- Amiloride (Midamor)

- Spironolactone (Aldactone)


  • Certain drugs used to lower blood pressure, among others

- Ramipril (Altace)

- Enalapril (Vasotec)

- Irbesatran (Avapro)

- Candesartan (Atacand)  and others ending in –pril or  –sartan

- Certain antibiotics (tetracycline)

- Avoid over-the-counter medications containing iodine

  • Alcohol, Marijuana

Side effects​

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.


Side effects 

(at the start of treatment  and increases  doses)



  • Slowing of intellectual functioning

  • Decreased memory and concentration

  • Dizziness

  • Headache

  • Increased thirst

  • Metallic taste in the mouth

  • Dry mouth



Slight hand tremors



  • Nausea

  • Vomiting

  • Abdominal cramps

  • Increased amount of urine

  • Diarrhea



  • Decreased sexual appetite

  • Inhibition of erection



  • Loss of appetite

  • Weight increase



  • Apathy

  • Fatigue

  • Lethargy or muscle weakness


Long term effects



  • A goiter (swelling of the neck)  especially in women

  • Difficulty speaking

  • Dizziness

  • Ringing in the ears

  • Involuntary movements of the muscles or the eyeball

  • Visual distortions



Lack of coordination



Cardiovascular problems



Slowing of bladder and bowel functions



  • Kidney damage

  • Malfunction of the thyroid gland


Less common side effects



  • Hair lightening

  • Eye irritation



  • Swollen ankles or wrists

  • cold hands






  • Bloated feelings

  • Difficulty breathing



  • Infertility in men

  • Milk production in women



  • Lack of skin sensitivity

  • Hand discoloration accompanied by pain

  • Heat or cold intolerance



Loss of appetite



Tendency to oversleep







Side effects detectable during medical examinations



Abnormal heart rhythm



  • Decreased production of thyroid hormones

  • Onset of diabetes insipidus (extremely dilute, sugarless urine)

  • Aggravation of diabetes mellitus

  • Decreased kidney function

  • Elevated white blood cell count

Intoxication reactions

These effects are concerning when they appear together in a person who had no side effects. A serum lithium level is usually obtained to help the physician with management. Treatment is usually temporarily stopped.


The most common signs of overdose are:

  • Encephalopathy (brain disorder of toxic origin or related to degeneration)

  • Muscular weakness

  • Lack of coordination

  • Drowsiness

  • Dizziness

  • Ataxia (disorders in the coordination of movements)

  • Nystagmus (an involuntary rhythmic oscillatory movement of both eyes or much more rarely of only one eye)

  • Tremors

  • Vigilance disorders

  • Hyperreflexia (exaggeration of reflexes)

  • Seizures

  • Coma

  • Digestive disorders

  • Electrocardiographic changes: arrhythmia

  • Dehydration and renal insufficiency especially during massive overdoses


In case of overdose, hospitalization is necessary. Adjunctive treatment should be implemented, if necessary. Diuretics should not be used.


In certain cases of overdose with renal insufficiency or severe intoxication (for example with coma), the remedy

extrarenal purification (purification of the blood from body waste in the event of renal function failure) may be necessary.


Prolonged monitoring is recommended.

Monitoring and medical surveillance ​

Actions one can take to avoid iatrogenic effects (which are caused by medicine).


  • Regular weight monitoring

  • Blood tests

  • Examination of the functioning of the thyroid gland

  • Examination of kidney function (check with your doctor if you need to be on a lithium fast,  food and water)

  • Examination of the heart after 40 years


Lithium is a basic drug to treat certain mood disorders. Its use has declined in recent years (replaced by anticonvulsant drugs used as mood stabilizers), in particular because of its side effects, particularly concerning the kidneys and the thyroid gland. In addition, its use requires precise medical monitoring because of its toxicity if the dosage in the blood is too high. It has a calming effect on anyone who uses it for a long enough period. It begins to take effect after three to four weeks. Since one of its side effects is having dry mouth, it is recommended to drink 8 to 10 glasses of water a day, but no more, so as not to dilute the lithium level in the blood. Finally, a fundamental clarification: no one has lithium naturally in their blood. Some traces are possible, caused by pollution (eg: living near a factory that produces lithium batteries).

Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this area. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.


Common and frequent withdrawal symptoms for all classes: anxiety, nervousness, restlessness, sleep problems, greater need to rest, sleep, irritability, fatigue.

Withdrawal symptoms for lithium:

Withdrawal reactions are not necessarily apparent, but emotional difficulties, anxiety, irritability and insomnia may reappear. The risk of crisis seems to be highest during the first 12 weeks.

Because withdrawal is sometimes accompanied by one or more relapses, some people do not manage to wean themselves definitively.


Main psychological withdrawal symptoms:

  • Return of episodes of mania or depression

  • Anxiety

  • Irritability

  • Hustle

  • Insomnia and other sleep-related problems

  • suicidal tendencies


Main physical withdrawal symptoms (rare):

If the person had lithium-induced hypothyroidism, they may have hyperthyroidism at the time of cessation, regardless of the duration of withdrawal.

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