To contact us please call 212.249.1600

Lithium FAQ's

»Lithium Frequently Asked Questions. Answers taken from Second Opinion on Lithium Therapy for Depression and Manic Depression by Ronald R. Fieve, MD.

What is Lithium?

Lithium is an alkali metal found widely in nature. It is found in small amounts in plant and animal tissue, as well as mineral waters. Certain rocks contain a large amount of lithium: they are the main source of lithium for medical and industrial uses.

As a medication, lithium is administered as a salt available under the generic names of lithium carbonate and lithium citrate. Manufacturers of lithium also assign “trade names” to their products, such as Eskalith, Lithane, Lithotabs, Cibalith-S, and others. These products are available in capsule or in tablet form, usually in 300 mg or, less commonly, in 450mg strength. Lithium citrate is available as a liquid.

When is Lithium used?

Lithium is used most effectively in the treatment of mental or emotional disorders characterized by wide-ranging mood swings, fluctuating from a state of depression to one of elation. This emotional disorder is referred to as a manic despressive disorder or bipolar disorder. On set occurs most often between the ages of 20 and 30, but it may begin in childhood, adolescence or as late as 50 or 60.

Most patients suffering from bipolar affective disorder will experience recurring episodes of “highs” and “lows” separated by periods of normal functioning. Patients experiencing mania (i.e., periods of elevated mood) alternating only with normal functioning (i.e., unipolar mania, which is not common) are also considered to be manic depressive. Prophylaxis of manic depression is accomplished with lithium often taken for many years.

Patients who have recurring depressions alternating with normal periods are considered to suffer from recurrent unipolar (major) depression and are distinct group, three to four times as common as those with a bipolar disorder. Both bipolar and unipolar groups are thought to have underlying chemical imbalances, with biogenetic components. Prophylaxis of recurrent unipolar depression may be achieved with antidepressants along, with lithium alone, or with a combination of lithium and antidepressants, such as tricyclics, monoamine oxidase inhibitors (MAOI’s), the selective serotonin reuptake inhibitors (SSRI’s), and bupropion or venlafaxine.

While it is possible for bipolar patients to suffer a single affective episode, recurring or cycling manias and depressions are more common. Follow-up studies of unipolar depression have shown that, in general, only 20% of patients have a complete remission after just one episode.

Many lithium experts in the United States employ lithium as a preventative agent for recurring depression, as well as for manic depression. Drug regulatory agencies in England, Denmark and many other foreign countries have approved this usage of Lithium. However, in the United States the Food and Drug Administration has, as of 1993, given technical approval only for the use of lithium in manic depression.

How does Lithium work?

It is thought that lithium helps to correct the chemical imbalance in certain brain cells that control emotion and behavior. Lithium has no appreciable effect on normal mood states, and it is entirely excreted by the kidneys. Normal sodium (a component of table salt) intake, adequate fluids and normal metabolism in medically healthy individuals are important in achieving a safe lithium blood level and in preventing lithium toxicity.

If, for any reason, patients taking lithium ingest limited or restricted quantities of sodium of fluid (especially when in tropical climate or during episodes of diarrhea, vomiting or dehydration), lithium will accumulate in the body and may cause a serious toxic reaction (see lithium toxicity). In such instances, the intake of lithium must be stopped immediately. Normal salt and fluid intake is, therefore, extremely important for someone who is on lithium.

What is mania?

A manic episode may manifest itself in excess of energy, increased activity, pressured speech, and reduced need for sleep (2 to 4 hours a night). It is common for manic patients to make multiple long distance telephone calls, spend money excessively, or travel impulsively. Thy often become irritable and irritating, exhibiting uninhibited behavior, increased libido, feelings of grandiosity, as well as lack of good judgment. Their thought processes may are speeded up, new ideas come rapidly and concentration may be deficient, but confidence is boundless.

In milder form, these “hypomanic” periods can be useful, highly creative and productive. Untreated, they may accelerate from mild mood elevation to rage attacks, periods of euphoria, then confusion, disorientation, and finally psychosis requiring hospitalization.

What is depression?

A depressive episode is characterized by sadness, difficulty sleeping, or sleeping too much, as well as appetite disturbance that may lead to significant weight loss or weight gain. In depressed individuals, there is usually a profound lack of energy, lack of enjoyment or pleasure, self-criticism, a feeling of lethargy, hopelessness and worthlessness. The patient may become withdrawn, neglect personal grooming and be unable to concentrate or make the smallest decisions. He or she may feel like crying yet be unable to do so. The patient may also experience various levels (from little to great deal) of anxiety and increased preoccupation with bodily functions. In addition, guilt feelings, ruminations and an increasingly pessimistic attitude toward the future are common.

Sometimes the patient reaches a point where everything seems too much of an effort and going on seems impossible. Suicidal thoughts and/or attempts are most often presented in severe depression. Hospitalization is then usually warranted.

While depression typically lasts 3 to 8 months, if untreated, it can be as short as 2 to 3 weeks, or it may last for years—in which case it is considered chronic.

How common are bipolar and unipolar disorders?

It has been estimated that at any given time 1% to 1.5% of the total population is suffering from some form of primary (physical/genetic) bipolar depressive disorder. According to the National Institute of Mental Health, between 5% and 6% of the general population suffers at one time from primary unipolar (major) depression, while another 10% suffers from some form of reactive or secondary depression (as a reaction to situational stress, for example, of a financial or personal nature, or secondary to another pre-existing psychiatric illness, such as neurosis, alcoholism, drug addiction; or secondary to primary medical illness), bringing the total number of people affected at any given time to 25 to 30 million in the United States alone.

If you buy or download the complete handbook, A Second Opinion on Lithium Therapy for Depression and Manic Depression by Ronald R. Fieve, MD, you will have the answers to all the questions above as well as many more, such as:

How does Lithium work?
Will Lithium work for me?
Does Lithium cure Manic Depressive Disorder?
What are some of the side effects of Lithium?
Does Lithium cause weight gain?
Does Lithium affect sexual function?
What are some of the side effects of Lithium?
Is Lithium habit forming?
What about travel and Lithium?
What about alcohol and Lithium?