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What
is lithium?
Lithium carbonate--a salt--came to be regularly used to control
manic depression in this country in the 1970's. Today it is
the second most commonly used medication to treat bipolar
disorder (manic depression). There are a variety of different
brands of lithium dispensed in tablets, capsules, and liquid
form: Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate,
and Lithotabs. Lithium is helpful in 70 percent to 80 percent
of people with bipolar disorder, making it one of the most
effective psychiatric medications available.
What
does lithium treat?
Lithium has been most frequently and effectively used to control
and prevent manic episodes in persons with bipolar disorder.
Lithium has been successful in treating depression as well.
In fact, the occurrence of depression in a person with bipolar
disorder who has been taking lithium is often an indication
that a higher dose is needed. In some cases, lithium is even
a successful treatment for those with unipolar depression,
or those who have never had a manic episode. Individuals who
respond to lithium for depression are often those who have
not responded to tricyclic antidepressants after several weeks
of treatment. When given lithium in addition to their antidepressants,
some of these people have shown significant improvement.
Lithium
has also successfully treated schizophrenia in cases where
there is a schizophrenic thought disorder accompanied by a
change in mood that mimics either mania or depression. The
similarity between people with this type of schizophrenia
and those diagnosed with manic depression is their mood disorder--that
is, the experience of strong emotions not related to what
is happening in the environment. People with schizophrenia
not experiencing a mood disorder will not likely respond to
the combination of lithium and antipsychotic medication.
How
long does lithium take to work?
For lithium to reach its maximum effectiveness, two or even
three weeks are often required. To control severe mania, doctors
often will prescribe an antipsychotic drug while waiting for
lithium to take affect. When the manic symptoms disappear,
the antipsychotic may sometimes be discontinued, but the lithium
continued.
Some people on
lithium report having breakthrough depression. These individuals
may respond to an increase in the dosage or the addition of
an antidepressant. When depressions occur in those who have
been taking lithium and who are able to tolerate a higher
dose, it is possible that the dosage has been inadequate.
What
are the side effects of lithium?
Common side effects of lithium include nausea, loss of appetite,
and mild diarrhea. These usually will taper off after the
first few weeks. Dizziness and hand tremors have also been
reported, and tremors can be diminished effectively if the
dosage of lithium is gradually decreased. Medications that
control tremors include the beta-blockers like Inderal. With
Inderal, however, there may be a lowering of the patient's
blood pressure and heart rate, and sudden discontinuation
can cause anxiety and tremulousness.
Increased
production of urine and excessive thirst are two common side
effects that are usually not serious problems, but patients
with kidney disease should not be given lithium. Midamor is
a drug that can reduce urinating. Taking the day's dosage
of lithium at bedtime also seems to help with the problem
of increased urination. Other side effects of lithium include
weight gain, hypothyroidism, increased white blood cell count,
and skin rashes.
People
who are taking lithium should consult their doctor before
taking the following: Ibuprofen (Advil), acetazolamide, antihypertensives,
anti-inflammatory drugs, calcium channel blockers, carbamazepine,
diuretics, or muscle relaxants.
While on lithium,
a patient's blood level must be closely monitored. If the
blood level of lithium is too low, the patient's symptoms
will not be relieved. If the blood level of lithium is too
high, there is a danger of a toxic reaction. It is very important
not to become dehydrated or to start a low salt diet while
on lithium. Consumers should tell their doctor immediately
if they develop nausea, vomiting, diarrhea, confusion, or
an increase in tremulousness.
Are
there specific concerns about lithium and pregnancy?
A study was done in 1992 to measure the effect of lithium
on unborn babies. It was found that exposure to lithium during
the first trimester of pregnancy might be associated with
the increased risk of Ebstein's anomaly, a rare cardiac malformation.
Otherwise, the rate of congenital malformations did not differ
between the group that took lithium and the control group.
Birthweight, however, was found to be significantly higher
in the lithium group, despite the high percentage of lithium
users who were also cigarette smokers (almost twice as many
as the control group). More recently, scientists have come
to doubt that lithium produces adverse effects on the fetus
and psychiatrists are increasingly willing to prescribe it
to pregnant women with bipolar disorder.
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