"Licensed as a psychiatric nurse practitioner more than 20 years ago, I thought I'd never need or want to prescribe lithium. Old school, I thought. A 1950s drug; we have much better now. It's true, lithium was known for ghastly side effects; lots of them, and bad: thyroid and kidney disorders, brain fog, tremors, GI issues, weight gain, and more. No way would I submit patients-many who were women seeking pregnancy -to those."
"Much more salient today, lithium's negative effects are, like most drugs, dose-dependent: The higher your dosage, the more likely you are to suffer side effects. Keep doses low, and mild to no side effects appear. And due to two things-(1) side effects being dose-dependent and (2) the advent of newer meds used in conjunction with lower lithium-prescribing changed dramatically. There are multiple contexts where lithium outdoes any other mood stabilizer, especially in bipolar disorder, where lithium is still a gold standard."
"Antisuicide effects: Lithium is the only drug we have that offers antisuicide effects. An element in nature, lithium so effectively lowers suicide rates that a Texas study found higher concentrations of lithium in public water lowered suicides. We don't know the mechanism of action-the why of lowering suicides-but we definitely know it works. In the past, people were prescribed lithium doses up to 1,800 mg per day."
Low-dose lithium produces far fewer and often mild or no adverse effects compared with historically high doses. Historic high-dose use caused thyroid, kidney, cognitive, tremor, gastrointestinal, and weight-related adverse effects. Lithium remains a gold-standard mood stabilizer for bipolar disorder and uniquely reduces suicide risk, with ecological evidence linking higher public-water lithium concentrations to lower suicide rates. Modern practice uses substantially lower daily doses (often ~400 mg versus past doses up to 1,800 mg) and combines lithium with other medications—such as lamotrigine—in synergistic regimens. Lithium also promotes neurotrophic growth and may help prevent or treat dementia.
Read at Psychology Today
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