Lithium
Generic: lithium carbonate / lithium citrate · Brand: Lithobid® / Eskalith® · Class: Mood Stabilizer
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How It Works
Lithium is a naturally occurring mineral and the gold standard mood stabilizer. Its exact mechanism is not fully understood, but it is believed to modulate neurotransmitter activity (serotonin, dopamine, norepinephrine) and stabilize neuronal signaling through effects on second messenger systems. Lithium has the strongest evidence base of any mood stabilizer and is the only medication proven to reduce suicidality in bipolar disorder. It requires careful monitoring because the therapeutic range is narrow — levels too low are ineffective, levels too high can be toxic.
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What It Treats
Bipolar I DisorderGold standard for acute mania and long-term maintenance — strongest evidence of any mood stabilizer
Bipolar II DisorderEffective for hypomania and depression prevention
Suicidality ReductionOnly mood stabilizer with strong evidence for reducing suicide risk in bipolar disorder
Schizoaffective DisorderUsed as adjunct for mood stabilization
Augmentation for DepressionUsed off-label to boost antidepressant effectiveness
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Dosing Overview
| Population | Start | Typical Range | Target Level |
|---|---|---|---|
| Adults Acute Mania | 300 mg 2–3x daily | 900–1800 mg/day | 0.8–1.2 mEq/L |
| Adults Maintenance | 300 mg 2–3x daily | 600–1200 mg/day | 0.6–0.8 mEq/L |
| Older Adults Start low | 150–300 mg daily | 300–900 mg/day | 0.4–0.7 mEq/L |
Dose adjusted based on blood levels — NOT by weight. Levels checked 12 hours after last dose. Extended-release (Lithobid) taken twice daily; immediate-release taken 2–3 times daily. Always take with food and plenty of water.
🔬 Required Monitoring
Blood LevelEvery 3–6 months (more often when starting or changing dose)
Kidney FunctionBUN/creatinine every 6 months — lithium affects kidneys long-term
Thyroid FunctionTSH every 6 months — lithium commonly causes hypothyroidism
Calcium LevelAnnually — lithium can affect parathyroid function
EKGBaseline and as needed — lithium can affect heart rhythm
Hydration StatusMaintain consistent fluid and salt intake daily
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Side Effects
Common
- Tremor (fine hand tremor)
- Increased thirst and urination
- Nausea
- Weight gain
- Cognitive dulling or memory issues
- Acne or psoriasis flare
- Hypothyroidism (fatigue, weight gain)
- Diarrhea
Call us if you notice
- Lithium toxicity signs (see warnings)
- Severe tremor or muscle twitching
- Confusion or altered mental status
- Signs of kidney problems
- Signs of hypothyroidism
Fine hand tremor is very common and usually not dangerous — it often improves over time or with dose adjustment. Staying well hydrated and maintaining consistent salt intake is critical. Dehydration, illness with vomiting/diarrhea, or NSAIDs can all raise lithium levels to toxic ranges.
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Tips for Success
Same Time DailyTake at the same time each day for consistent blood levels.
With FoodTaking with food reduces stomach upset for most mood stabilizers.
Never Stop AbruptlyStopping suddenly can trigger a mood episode. Always taper with your provider.
Limit AlcoholAlcohol can worsen mood instability and interact with these medications.
Tell All ProvidersMood stabilizers interact with many medications — always share your full list.
Keep Lab AppointmentsBlood level monitoring is essential for safety — never skip labs.
Stay HydratedDrink consistent amounts of water daily. Dehydration can cause lithium levels to spike dangerously.
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Important Safety Information
Lithium Toxicity — Medical Emergency: Symptoms include coarse tremor, slurred speech, confusion, vomiting, diarrhea, muscle twitching, and in severe cases seizures or coma. Go to the ER immediately if you experience these. Do not take another dose.
NSAIDs Raise Lithium Levels: Ibuprofen (Advil, Motrin), naproxen (Aleve), and other NSAIDs can significantly raise lithium to toxic levels. Use acetaminophen (Tylenol) instead for pain.
Salt and Fluid Changes Are Dangerous: Crash dieting, low-sodium diets, excessive sweating, vomiting, or diarrhea can all dramatically raise lithium levels. Maintain consistent salt intake and hydration.
Pregnancy: Lithium carries a small risk of cardiac defect (Ebstein anomaly) in the first trimester. Do not stop without carefully discussing risks and benefits with your provider.
Kidney and Thyroid Effects: Long-term lithium use can affect kidney function and cause hypothyroidism. Regular monitoring allows early detection and management of both.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, lab results, or your medication. Do not wait until your next visit if something feels wrong.
360-389-3712
info@rootedmindspsychiatry.com