Lithium is a medication commonly prescribed for mood disorders, such as bipolar disorder, and has many notable side effects. Side effects vary in severity, with some being more prevalent than others. Many side effects tend to subside over time as your body adjusts to the new medication.
What Is Lithium?
Lithium, a psychiatric medication that has been used for many years, is a mood stabilizer used in the management of mood disorders.1 The way lithium works is unknown and complex, but it likely alters the metabolism of certain chemicals in the brain that are involved in mood regulation. 2, 3
Lithium is FDA-approved for the following uses:3
- Manic episodes of manic-depressive illness (adults)
- Acute mania/mixed mania (for ages seven and older)
- Maintenance treatment for manic-depressive patients (adults)
- Bipolar disorder (ages seven and older)
Lithium is also occasionally used for off-label purposes. Off-label means that a provider is prescribing lithium for a non-FDA-approved use but feels that the medication may still benefit an individual.
Off-label uses of lithium include:3
- Bipolar depression
- Major depressive disorder
- Vascular headache
- Neutropenia (low white blood cell count)
Common Side Effects of Lithium
Lithium is associated with many side effects, though not everyone will experience them. Many side effects are mild and will improve as the body adjusts to the new medication. Other side effects can be severe or persistent, requiring immediate medical attention.
Common side effects of lithium include:1, 4
- Nausea
- Vomiting
- Increased thirst
- Increased urination
- Thyroid problems
- Tremors
- Dizziness
- Rash
- Problems with walking
- Decreased appetite
- Blurry vision
- Weight gain
- Sedation
- Fatigue
Severe Side Effects of Lithium
While lithium can be an effective treatment for mood disorders, it also has the potential to cause severe side effects that require immediate medical attention. Elevated levels of lithium in the bloodstream can lead to severe side effects. It is crucial to monitor blood lithium levels regularly to avoid toxicity.
Severe side effects of lithium include:2, 3, 4
- Kidney damage
- Irregular heart rhythm
- Low blood pressure
- Low heart rate
- Seizures
- Coma
- Delirium
- Allergic reactions
- Blackout spells
- Incontinence of urine or feces
Lithium Toxicity
One severe and potentially fatal condition associated with lithium use is lithium toxicity. This occurs when the level of lithium in the blood becomes too high, leading to a variety of serious symptoms that require immediate medical attention. Lithium toxicity can occur due to several factors, such as taking too much of the medication, dehydration, interactions with other medications, or impaired kidney function.
Dehydration is a significant risk factor as low blood volume increases the concentration of lithium. For this reason, it is important for individuals taking lithium to avoid dehydration by drinking plenty of fluids. It is also important for these individuals to talk with their healthcare provider when having illnesses that cause vomiting/diarrhea.
Early signs of lithium toxicity include diarrhea, vomiting, drowsiness, and muscular weakness.2 At high levels, symptoms can include giddiness, difficulty with coordination, blurred vision, and excessive urination.2 If there are concerns for lithium toxicity, immediate medical attention is necessary to prevent serious complications.
Symptoms of lithium toxicity include:2
- Diarrhea
- Vomiting
- Drowsiness
- Muscle weakness
- Problems with coordination
- Giddiness
- Excessive urination
- Tremors
- Muscular weakness
- Seizures
- Coma
Long-term Side Effects of Lithium
Long-term use of lithium can also lead to persistent side effects and can impact multiple organ systems. Regular monitoring of lithium levels in the blood is necessary to decrease the possibility of long-term side effects. It is also important to regularly monitor for long-term effects through regular checkups and lab work.
Long-term side effects of lithium include:1
- Thyroid problems (both hypothyroidism and hyperthyroidism)
- Goiter
- Kidney dysfunction
- Parathyroid dysfunction
- Elevated calcium levels
- Diabetes insipidus
- Weight gain
It is important to remember that individual responses to medications vary, and the side effects listed do not encompass all possibilities. If considering lithium treatment, it is essential to discuss the potential side effects with your healthcare provider. Your doctor can provide personalized recommendations enabling you to make informed decisions about your treatment plan.
Allergic Reactions
While allergic reactions to lithium are rare, they are crucial to recognize and address immediately. Allergic reactions can result in rashes, itching, and swelling of the face or throat. In severe cases, individuals can develop sudden drops in blood pressure, difficulty breathing, and loss of consciousness. If you are experiencing an allergic reaction to a medication, it is important to seek medical attention immediately.
Allergic reactions to lithium include:
- Hives
- Itching
- Swelling of the face, mouth, or throat
- Difficulty breathing
- Loss of consciousness
- Rapid heart rate
If you develop allergic reaction symptoms, immediate medical attention is vital. Your healthcare provider will be able to determine the severity of your symptoms and treat them appropriately. Depending on the reaction, it may be necessary to stop using lithium. In this case, your doctor can provide you with other options, such as trying a different mood stabilizer.
Interactions With Lithium
Lithium can interact with various medications, substances, and herbal supplements, posing potential risks and worsening side effects. Some medications can impact the lithium levels in the blood, increasing the risk of toxicity or reducing lithium’s effectiveness. It is essential to inform your healthcare provider about all medications, substances, and supplements you are using to minimize the risk of side effects.
10 substances you should avoid while taking lithium include:1, 2
- Diuretics: Diuretics can increase the concentration of lithium in the blood and increase the risk of lithium toxicity.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen, can decrease blood flow to the kidneys leading to reduced excretion of lithium. This can increase lithium concentration in the blood and increase the risk of lithium toxicity.
- Antidepressants: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can cause serotonin syndrome with symptoms including agitation, insomnia, confusion, and muscle rigidity.
- Antipsychotic medications: The use of antipsychotic medications with lithium can cause neurological symptoms, including confusion, weakness, and fever.
- Metronidazole: Metronidazole and similar antibiotics can increase the concentration of lithium in the blood and lead to lithium toxicity.
- Methyldopa: Methyldopa is used to treat hypertension. Taking lithium with methyldopa can increase the risk of side effects from methyldopa.
- Phenytoin: Phenytoin is used to treat certain seizure disorders. Taking lithium with phenytoin can increase the risk of side effects from phenytoin.
- Carbamazepine: Carbamazepine is used to treat certain seizure disorders. Taking lithium with carbamazepine can increase the risk of side effects from carbamazepine.
- Sodium-glucose cotransporter (SGLT2) inhibitors: SGLT2 inhibitors, such as canagliflozin and dapagliflozin, can decrease the lithium concentration in the blood, reducing its effectiveness.
- Neuromuscular blocking agents: These medications are often used in conjunction with anesthesia. Lithium can prolong the effects of these medications.
Who Experiences the Most Side Effects on Lithium?
Individual responses to lithium can vary widely, and some individuals are at an increased risk for side effects. Preexisting conditions, especially those with a history of thyroid or kidney problems, are more likely to experience complications when taking lithium. It is imperative to have open conversations with your healthcare provider about your health conditions before starting lithium. This will ensure that your healthcare provider has a comprehensive understanding of your medical history to determine the best treatment option.
Can Stopping Lithium Cause Withdrawal Symptoms?
Discontinuation symptoms are uncommon when stopping lithium. However, abrupt discontinuation can lead to a relapse of symptoms and may increase the risk of suicide.3 It is recommended to gradually wean off the medication over a 3-month period to avoid relapse.3
Other Warnings & Precautions For Taking Lithium
Taking lithium requires careful consideration of warnings and precautions to ensure safe and effective treatment. Certain individuals, such as those with heart, kidney, or thyroid problems, are at an increased risk for adverse effects when taking lithium. Lithium should be avoided in pregnant and breastfeeding mothers.
Precautions for taking lithium include:1, 2, 3
- Use while pregnant: Lithium can cause harm to a developing fetus and should typically be avoided during pregnancy.
- Use while breastfeeding: Lithium is excreted in breast milk and should not be taken when breastfeeding.
- Children: Lithium should be used with caution in children as they tend to have more frequent and severe side effects.
- Elderly: Elderly patients can be more sensitive to lithium and may require a lower dose.
- Those with kidney problems: Lithium can worsen kidney function, and kidney problems can increase the concentration of lithium in the blood.
- Those with Brugada Syndrome: Brugada Syndrome is a heart problem that can lead to a risk of sudden death. Lithium can worsen Brugada Syndrome and should be avoided in those with Brugada Syndrome or those suspected of having Brugada Syndrome.
Questions to Ask Your Healthcare Provider About Lithium Side Effects
If you’re considering using lithium as a treatment for a mood disorder and wish to learn more about its potential side effects, it’s essential to have a comprehensive discussion with your doctor, psychiatrist, and therapist. You may want to ask about specific side effects associated with lithium and if your medical history increases the risk of developing these side effects. Having an open conversation with your healthcare team will help you make informed decisions, ensuring the maximum benefit from your treatment plan.
Questions to ask your care team when considering the side effects of lithium may include:
- Can I use lithium along with therapy or other medications to treat bipolar disorder?
- How long will it take for me to adjust to taking lithium?
- Am I at risk for more severe symptoms if I am already taking medication for anxiety, depression, or other mental health conditions?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have harmful interactions?
- When should I reach out to you if I am experiencing side effects?
- Is there anything I should tell my therapist about this new medication?
- What should I do to decrease the risk of dehydration?
- What lifestyle adjustments should I consider to mitigate potential side effects?
- How frequently will I need to follow up?
- How often will I need to get labs drawn?
- What steps can I take to decrease the risk of lithium affecting my thyroid or kidneys?
In My Experience
In my experience, lithium can be a safe and effective treatment if used appropriately. It is important to keep in mind all the possible interactions between lithium and other medications or substances. Lithium can lead to serious complications if not monitored closely by your doctor, so it is necessary to follow up as recommended by the prescribing physician.
