Lithium (medication)

Lore & Background

In the nineteenth century, lithium was used for gout, epilepsy, and cancer. Its use in mental disorders began in the 1870s with Carl Lange in Denmark and William Alexander Hammond in New York City, who treated mania based on now-discredited theories involving uric acid. Lithium is primarily used as a maintenance drug for bipolar disorder to stabilize mood and prevent manic episodes, and it is also effective in acute mania within the first 7 days. It is sometimes used off-label for major depression, schizophrenia, impulse control disorders, and certain childhood psychiatric conditions. Lithium is proven to reduce suicide risk in mood disorders by 87% in randomized double-blind placebo-controlled trials, though some meta-analyses dispute this finding. Common side effects include increased urination, hand shakiness, and increased thirst. Serious side effects include hypothyroidism, diabetes insipidus, and lithium toxicity. Blood level monitoring is recommended; high levels can cause diarrhea, vomiting, poor coordination, sleepiness, and ringing in the ears. Lithium is teratogenic at high doses, especially in the first trimester, and its use during breastfeeding is controversial, with many health authorities advising against it.

Reader's Guide

Lithium remains a cornerstone treatment for bipolar disorder, listed on the World Health Organization's List of Essential Medicines and available as a generic medication. Its significance lies in its unique ability to prevent suicide in mood disorders, a property not shared by other psychotropic drugs. However, its use is limited by a narrow therapeutic index requiring regular serum monitoring of lithium levels, thyroid and kidney function, and risk of toxicity. Lithium appears to be underused in older people and in certain countries, partly due to patients' negative beliefs about the drug. Despite decades of use, its mechanism of action remains unknown, though studies show it partially reverses telomere shortening and increases mitochondrial function in bipolar patients. The drug's legacy includes its role as a mood stabilizer, its efficacy in reducing dementia risk by 50% in bipolar disorder, and its association with lower suicide rates in populations with trace lithium in drinking water.

Did You Know?

• Lithium is unique among medications in that it is proven to prevent suicide in mood disorders such as bipolar disorder and recurrent major depression.
• Lithium reduces the risk of dementia by 50% among people with bipolar disorder.
• The increased presence of trace amounts of lithium in drinking water is correlated with lower overall suicide rates, especially among men.
• Lithium is teratogenic and can cause birth defects at high doses, especially during the first trimester of pregnancy.