Lithium is a type of medication used to treat patients with bipolar disorder, and sometimes depression.
Lithium helps manage symptoms of mania and depression.
Lithium is also used to reduce the risk of suicide in patients.
This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist, and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.
Lithium is one of the most widely-used medications for the treatment of bipolar disorder because it decreases suicidal thoughts — a leading cause of death in those with bipolar — and helps manage both manic and depressive episodes.
But, lithium may not be the best choice for everyone with bipolar disorder. Here is what you need to know about how lithium works and its side effects.
What is lithium used for?
Lithium is part of a class of psychotherapeutic drugs known as mood stabilizers. It is primarily used in the treatment of bipolar disorder, but is sometimes also used to treat patients with severe depression or schizoaffective disorder, says Michael Ingram, MD, and psychiatrist who runs a private practice in Los Angeles, California.
While other medications might work better for some people, lithium remains a common form of treatment for stabilizing manic episodes, characterized by racing thoughts, grandiosity, decreased need for sleep, and hallucinations, says Shayla Sullivant, MD, a child and adolescent psychiatrist at Children's Mercy Hospital in Kansas City, Missouri. It can also be used as a maintenance drug to prevent future manic and depressive episodes.
"Lithium is one of the most effective medications we have for preventing both mania and depression in patients with bipolar disorder," says Ingram.
A 2015 review published in the International Journal of Bipolar Disorders examined more than 20 years of research on the use of lithium to treat bipolar disorder. It found lithium reduced the risk of suicide in patients by up to 75% compared with other drugs, like valproate, and a placebo.
Meanwhile, a 2020 review published in Frontiers in Psychiatry found lithium reduced the risk of new manic or depressive episodes by 25% compared to placebo. However, more research needs to be done comparing lithium's effects to other mood stabilizers like valproate.
How does lithium work?
Lithium has been used in the treatment of bipolar disorder for several decades, yet how it works exactly is not yet fully understood, Sullivant says. It is thought to work on the central nervous system, primarily the brain and spinal cord. And, according to studies performed on animals, it boosts serotonin transmission, which is a hormone that helps regulate mood.
Most patients notice a positive change within one to three weeks of starting Lithium, Ingram says, but this varies depending on many factors, like medical history and if someone is taking other medications.
Patients typically start out on a low dose taken twice a day. But some people may require only one dose a day or up to three depending on the severity of their symptoms, Sullivant says. For the average person, a dose of lithium can range anywhere from 300 mg to 1,800 mg a day.
Who should not take lithium?
Lithium is typically the preferred form of treatment for bipolar disorder, but the amount needed to reduce symptoms can be close to toxic levels in the body, Ingram says.
A therapeutic level of lithium, meaning the amount of lithium in the blood to effectively manage symptoms, is between 0.6 milliequivalents per liter (mEq/L) and 1.2 mEq/L. A blood level of 1.5 mEq/L can lead to toxicity. For this reason, your doctor will closely monitor lithium levels in your blood and may change your dosage accordingly.
Elderly patients over the age of 70 are more sensitive to lithium and may require a lower dosage than younger adults.
Lithium is typically avoided during pregnancy because it can put the fetus at a greater risk of developing a heart condition like a congenital heart defect, Sullivant says. But untreated bipolar disorder during pregnancy and the postpartum period also poses risks such as an increased risk for postpartum depression. Therefore, each patient should discuss with their doctor to determine the best course of treatment.
Other health conditions that could prevent someone from taking lithium include:
Kidney disease. Lithium may decrease kidney function, which could lead to kidney failure if you already have kidney disease.
Any health condition that can lead to diarrhea or vomiting, like irritable bowel syndrome or Crohn's disease, which can lead to dehydration and increase lithium concentration in the body.
Heart disease. Lithium can exacerbate heart problems like arrhythmias and even increase the risk of a heart attack in some patients.
Decreased thyroid function. Lithium can contribute to hypothyroidism, so it is not advised for patients with thyroid issues.
Lithium in combination with other high potency antipsychotics, like haloperidol, could lead to neurotoxicity, which can damage the brain and nerves, Ingram says.
Lithium is also excreted through the kidneys so it is typically not recommended if you are on another medication that also relies heavily on kidney function like a diuretic, Sullivant says.
Side effects of lithium
According to a 2016 study published in the International Journal of Bipolar Disorders, as many as 90% of people taking lithium experience at least one side effect from the drug.
Some common side effects include:
Alopecia, which is sudden hair loss
"While there is certainly risk in taking [lithium], there is also great risk in not treating a condition like bipolar disorder and these risks need to be weighed," says Sullivant.
When to seek medical aid
Too much lithium in your blood can lead to lithium toxicity, which can cause seizures and brain injury.
You should seek medical attention if you experience signs of lithium toxicity, which include:
Impaired balance and coordination
Read more about the signs and symptoms of lithium toxicity.
The bottom line
While lithium can cause side effects, and may not be the best choice for everyone with bipolar disorder, it is effective at decreasing suicide risk and managing symptoms of mania.
"Lithium is life-saving for some, particularly those with bipolar disorder who struggle with suicidal thoughts," says Sullivant. "So, while there is certainly risk in taking it, there is also great risk in not treating a condition like bipolar disorder."
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