Lithium: Bipolar disorder’s gateway drug


“I’m so happy because today I found my friends, they’re in my head.”

– Nirvana, Lithium

There are dozens of different medications available on the market for the treatment of bipolar disorder, yet one has remained the main go-to for nearly a century.

I’m talking about lithium. For more than 70 years, lithium has been the “gold standard” drug usually prescribed after getting one’s initial diagnosis. After all this time it is still considered to be one of the most effective medications for the disorder. But like everything else concerning this disease, the benefits can always come at a cost.

Lithium, a naturally occurring element, was first used in the 19th century for the treatment of gout. Scientists believed the element helped to naturally break down uric acid. However, the level of lithium needed to do so was toxic.

It was then discovered lithium was a good treatment for episodes of both mania and depression, but particularly mania. It has been used as a treatment for such ailments since the 1870s.

However, it was Australian psychiatrist John Cade, who in 1949 wrote one of the first papers on lithium as a treatment for mania, in turn making it a more widely prescribed medication.

Although used regularly since Cade’s discovery, the FDA didn’t approve the drug until 1970. Despite being one of the main drugs prescribed for the treatment of bipolar disorder, lithium, like any other drug, still has many possible side effects including:

  • nausea
  • shaking
  • dry mouth
  • frequent urination
  • diarrhea
  • weight gain
  • increased thirst
  • loss of appetite
  • kidney trouble
  • lowered activity
  • fatigue
  • emotional numbness or a dull feeling

There are, however, more serious side effects from taking lithium than those listed above. It is important to stay hydrated and get regular lab work done to monitor and prevent lithium toxicity in the blood.

Signs of lithium toxicity include:

  • trouble concentrating
  • confusion
  • fatigue
  • vomiting and diarrhea
  • poor coordination
  • muscle weakness, twitching, and tremors
  • an abnormal heart rhythm
  • seizures

Doctors will also check creatine levels to monitor kidney function. This is another long-term effect of the use of lithium. If creatine levels are too high this may be a sign of improper kidney function and can cause kidney disease.

It is still not completely known why lithium is so helpful in the treatment of bipolar disorder since a decreased level of lithium in the body doesn’t increase one’s chances of developing bipolar disorder. It is known, however, that lithium positively interacts with a number of neurons and neurotransmitters in brain cells.

Described in one 2017 study as “an oldie but a goodie”, lithium continues to be one of the more reliable mood stabilizers used for the treatment of bipolar disorder.

With there being dozens of different medications available for the treatment of bipolar disorder, one has remained a main go-to for nearly a century: lithium.

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