Which of the following is not a side effect of lithium in the treatment of mood disorders?

Lithium is a mood stabilizer used to treat bipolar disorder, a condition that involves episodes of depression, mania, and hypomania. Lithium is used as an acute treatment for mood episodes and as a long-term treatment to prevent further manic and depressive recurrences.

Lithium smooths out the highs of mania and the lows of depression in people living with bipolar disorder by restoring the balance of neurotransmitters in the brain.

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Neurotransmitters are chemical messengers that boost, carry, and balance signals between neurons (nerve cells) and target cells throughout the body. Too much or too little of any one neurotransmitter can upset the balance of brain activity, which manifests itself as changes in the way people think, feel, or behave.

Lithium has been considered a first-line treatment for bipolar disorder. Various studies have found that lithium is effective in preventing and reducing the frequency of mood episodes, manic episodes, and depressive episodes. It can decrease manic episode symptoms like elevated or irritable mood, racing thoughts, agitation, and decreased sleep.

However, lithium has been prescribed less and less in recent years. Reasons include its side effects, the availability of other mood stabilizers, and lithium's potentially high toxicity burden. 

Lithium is a chemical element found in nature. It is a light, soft metal that is used in a variety of forms. Some of these forms, such as lithium carbonate, are used to make the medications that treat bipolar disorder.

History

Lithium's use in psychiatric treatments for mood disorders dates back to the 19th century. It was not widely used, but its benefits for metabolic disturbances and gout were assumed to be linked to mood dysregulation, and recurrent mood disorders were well documented in medical papers.

Widespread acceptance and adoption of lithium in the United States took place in the 1970s. Its use in America decreased gradually beginning in the late 1980s, however, with the introduction of anticonvulsants and atypical antipsychotics, which are categories of medications used to treat other conditions that have also been increasingly used to treat bipolar disorder.

Mood disorders, also known as affective disorders, are a group of mental disorders characterized by clinically significant changes or extremes of mood.

Lithium is better than anticonvulsants at preventing manic episodes. And it reduces the relapse of mood symptoms, decreases aggression, and possibly also decreases impulsivity. Lithium can also reduce the risk of suicide in people who have mood disorders.

How Does Lithium Work?

Lithium belongs to a class of medications called mood-stabilizing agents, which are medications used to treat bipolar disorder and other mood disorders. It has not been established which of lithium's many effects is responsible for its mood-stabilizing properties, but it is known that lithium decreases irregular activity in the brain by altering the metabolism of neurotransmitters, notably dopamine and serotonin, as well as having other effects on nerve cells in the brain.

Levels of dopamine and serotonin can impact mood, anxiety, and many other brain functions. Other neurotransmitters that have been found to be involved in the pathophysiology of bipolar disorder include norepinephrine, GABA, and glutamate.

Uses

Lithium is primarily used to treat the symptoms of bipolar disorder—mania, depression, and fluctuations between the two states. It can be taken in the form of a tablet, liquid, or capsule and must be taken exactly as directed by a healthcare provider.

Lithium is meant to be used as a long-term treatment. Those who are taking lithium should not stop taking the medication even if they are feeling better. Missing doses of lithium may increase the risk of a relapse of mood symptoms. For the medication to function properly, those who are taking lithium must follow their healthcare provider's instructions on when, how much, and how often to take it.

In addition to bipolar disorder, lithium may be prescribed off-label for treating a variety of conditions such as non-bipolar depression, vascular headaches, and neutropenia. Off-label uses are not approved by the U.S. Food and Drug Administration.

Benefits

Lithium is not prescribed as often as it was in the past due to its potential toxicity burden and the availability of newer mood stabilizers. But research shows that it is still a reliable and effective treatment for bipolar disorder and could have beneficial effects in the treatment or prevention of some other conditions, including:

• Other mood disorders
• Suicide prevention
• Certain neurodegenerative diseases

Precautions

Those who are taking lithium can take the following precautions:

• Avoid drinking alcohol or using an illicit drug
• Avoid low-sodium diets and dehydration
• Avoid over-the-counter and prescription pain medications that contain nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen
• Avoid excessive intake of caffeinated beverages, such as coffee and tea

Let your healthcare provider know what prescription and over-the-counter medications, herbs, and supplements you are currently taking to avoid an adverse drug interaction. Always use lithium as exactly directed by your healthcare provider and avoid taking too much of the medication.

Side Effects and Risks

Therapeutic levels of lithium are very close to toxicity levels. Adverse side effects are correlated with dosage. As a result, you need to be closely monitored by your healthcare provider while taking Lithium. Lithium blood levels can help determine optimal dosing.

Common side effects of lithium include:  

• Diarrhea, or indigestion
• Acne-like rash
• Dry mouth or excessive saliva
• Hair loss or thinning
• Mild tremors
• Weight gain

The following signs could indicate toxicity and a need for medical evaluation: 

• Unusual tiredness
• Frequent urination (possible diabetes insipidus)
• Tremors that are jerky or hard to control
• Irregular heartbeat
• Dizziness or confusion

A number of studies have looked into ways to manage the side effects of lithium. For most people, these effects are mild. More intense side effects can be addressed by adjusting the dosage or medication schedule, changing the lithium formulation, and treating side effects with the appropriate medications.

Blood tests may be used to assess for side effects, such as changes in blood cell counts, thyroid, or kidney function.

Who Should Not Take Lithium?

Lithium should be used with caution or may not be recommended for patients with renal impairment, cardiovascular disease, and children under 12 years.

Its use in pregnancy is associated with congenital disabilities for infants, such as Ebstein’s anomaly, a heart valve defect. Even though the risk of Ebstein’s anomaly from first-trimester use of lithium is very low, an ultrasound of the baby's heart is recommended at 16 to 20 weeks of the pregnancy if someone is taking lithium while pregnant. Lithium levels should be monitored closely in early pregnancy and near delivery.

Those who are pregnant must weigh the risks and benefits of taking lithium with their healthcare providers. Breastfeeding is generally not recommended because lithium is excreted into breast milk. 

A Word From Verywell

Lithium can be a safe and effective treatment option for those with bipolar disorder or other types of mood disorders. Adhering to the dosage and medication schedule laid out by your healthcare provider will ensure you are getting the most benefit from lithium and avoid unwanted adverse effects from the medication. Living with a mood disorder can be a challenge, but treatment can substantially improve symptoms and improve quality of life.

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