Lithium Side Effects - Bipolar Medications

Lithium is a drug developed from a naturally occurring element that is often prescribed as a mood stabilizer for patients with bipolar disorder. Lithium is sold under many brand names, including Duralith, Eskalith, Lithobid, Lithotabs, Lithane, Lithizine and Lithonate. If you are taking lithium, you need to be aware of this medication's possible side effects.

Check with your doctor if any of the following Lithium side effects continue or are bothersome:

More Common: Increased frequency of urination; increased thirst; nausea; trembling of hands (slight)

Less Common: Acne or skin rash; bloated feeling or pressure in the stomach; muscle twitching (slight)

Early symptoms of lithium overdose or toxicity:

Diarrhea; drowsiness; loss of appetite; muscle weakness; nausea or vomiting; slurred speech; trembling

Late symptoms of overdose or toxicity:

Blurred vision; clumsiness or unsteadiness; confusion; convulsions (seizures); dizziness; trembling (severe)

Less Common: Fainting; fast or slow heartbeat; irregular pulse; troubled breathing especially during hard work or exercise); unusual tiredness or weakness; weight gain (may be significant)

Rare: Blue color and pain in fingers and toes; coldness of arms and legs; dizziness; eye pain; headache; noises in the ears; vision problems

Signs of Low Thyroid Function: Dry, rough skin; hair loss; hoarseness; mental depression; sensitivity to cold; swelling of feet or lower legs; swelling of neck; unusual excitement

Although increased thirst and increased urine output are very common side effects of lithium, it's important to tell your doctor if you have them. About 5% of patients on lithium develop lithium-induced NDI over time, which can be serious if not treated.

Other side effects not listed above may also occur in some patients. If you notice any other side effects, check with your doctor.

Lithium was first used for mental illnesses in the mid-19th century, but fell out of favor in the psychiatric world until it was brought back into use to treat mania around 1949. It has proven through time and research to be one of the most effective treatments for bipolar disorder in keeping moods stable and mood episodes at bay.

There has been renewed interest in the use of lithium recently because of its tolerability and effectiveness. Though it has side effects, these can generally be kept to a minimum by starting with a low dose and gradually increasing to the desired strength. Most side effects go away with treatment and many people stay on low doses of lithium for years with success. 

One notable characteristic of lithium is that it can have obvious side effects when you first start, yet not seem to be helping. However, this typically changes with some time, until you no longer experience the side effects, but do experience the mood stability. You should always let your doctor know if side effects don't go away and/or are distressing.

Common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Discomfort in the abdominal area
• Tremors
• Dry mouth
• Increased thirst
• Drowsiness
• Restlessness
• Constipation
• Hair loss

Rarely, serious side effects can occur. If you experience any of the following side effects, be sure to call your doctor right away or get emergency medical attention. 

• Fainting
• Confusion
• Hallucinations
• Seizures
• Blacking out
• Excessive and/or unusual tiredness or weakness
• Chest tightness
• Confusion
• Swelling in your ankles, feet or lower legs
• Strange movements that may be hard to control

There are a handful of ways to help keep side effects to a minimum as well as starting at a lower dose to begin with and working your way up. They include:

• Taking your medication with food to avoid abdominal upset or nausea
• Using an anti-diarrheal medication for a time, until your system adjusts to the lithium
• Taking doses throughout the day instead of using an extended-release form
• Sucking on a sugar-free lozenge to relieve dry mouth
• Potentially having your dose lowered if side effects do not decrease

If you or a loved one may have overdosed on lithium, be sure to contact your local poison control center and/or 911 right away. Symptoms of overdose may include:

• Loss of coordination
• Blurred vision
• Giddiness
• Vomiting
• Diarrhea
• Ears ringing
• Urinating often
• Weak muscles

You may have to take lithium for several weeks before you notice that it helps. Your doctor can give you some tips and tricks to help you deal with the side effects for those first few weeks until your system adjusts.

If you experience side effects that do not go away after a time, talk to your doctor about lowering your dose of lithium. Many patients will still do very well on a lower dose of lithium and without the side effects.

Sources:

McInnis, M.G. "Lithium for bipolar disorder: A re-emerging treatment for mood instability ." Current Psychiatry 13(6), 2014.

"Lithium." MedLine Plus, U.S. National Library of Medicine (2014).

Shorter, E. The history of lithium therapy." Bipolar Disorders 11 (0.2), 2009. 

Disclaimer: This is not intended to be all-inclusive or to replace information provided by your doctor or with the prescription from the manufacturer.