The Lithium Family

US Brand Names: Eskalith, Eskalith-Cr, Lithane, Lithobid, Lithonate, Lithotabs

See toward the bottom of the page for other brand names.

Generic Name: lithium carbonate

Other Forms: lithium citrate syrup

What is lithium carbonate: Officially lithium is classified as an antipsychotic.  Really it’s one of two true mood stabilizers.  All the other meds that people call “mood stabilizers” are really anticonvulsants and are best used as anti-manics.  The exception being Lamictal (lamotrigine), which is the other true mood stabilizer.

FDA Approved Uses of lithium:  Acute and chronic bipolar mania, approved by the FDA to treat bipolar disorder in 1970.  For thirty years the lithium meds were the only meds with FDA approval to treat mania that lasted longer than six months.  As of early 2004 Zyprexa (olanzapine) just received approval to also treat chronic mania.  We’re supposed to stay on our meds but there are only two meds approved for use long than six months.  Isn’t that crazy?

Off-Label Uses of lithium. Some of the other uses of lithium that don’t have FDA approval, but it will be prescribed for anyway include:

    • Cluster Headaches (although it still appears over the years not to be that effective)
    • Augmenting antidepressants to treat refractory depression
    • Graves’ Disease (hyperthyroidism)

Lithium’s pros and cons:

Pros: The gold standard for classic bipolar 1.  Inexpensive.  Consistent.  Available around the world.

Cons: The side effects suck donkey dong!  You need to have regular blood tests.  Changes in other meds, diet or even the seasons can require an adjustment in your dosage, but you’ll need a blood panel to determine that.  Usually doesn’t help much for non-standard forms of bipolar disorder (e.g. rapid cycling, bipolar 3-6).

Lithium’s Typical Side Effects: Weight gain, tremor (sometimes bad enough to require a beta blocker such as Inderal to quell it) and acne.  It’ll be just like two weeks before the Junior Prom and you still don’t have a date.
These aren’t all the side effects you can get, just the most popular ones.

 Lithium’s Not So Common Side Effects: While every day won’t be as bad of a hair day as with a valproate, lithium does mess with your hair.  Food will sometimes have a salty or weird metallic taste added to it.  There can be edema and other mysterious swellings.  You may not think as clearly as you did before you started taking a lithium variant.  While valproates may turn you instantly old, lithium will force you to relive your adolescence.
These may or may not happen to you don’t, so don’t be surprised one way or the other.

 Lithium’s Freaky Rare Side Effects: Anorexia, not feeling anything on your skin, not being able to move your limbs completely.  Those wacky adolescent fantasies about becoming a Barbie doll – lithium can make them happen!

Interesting Stuff Your Doctor Probably Won’t Tell You: Lithium toxicity has resulted from interactions between an NSAID and lithium. Indocin(indomethacin) and Feldene(piroxicam) have been reported to increase significantly steady-state plasma lithium concentrations. There is also evidence that other nonsteroidal anti-inflammatory agents, including the selective cyclooxygenase-2 (COX2) inhibitors (e.g. Celebrex), have the same effect. In a study conducted in healthy subjects, mean steady-state lithium plasma levels increased approximately 17% in subjects receiving lithium 450 mg BID with Celebrex (celecoxib) 200mg BID as compared to subjects receiving lithium alone.  Ibuprofen and Aleve(naproxen) can also affect lithium levels.One study testing the various products available had the same brand release differing amounts of lithium in different batches, and not everything labeled “sustained release” really was.  Yow!  This explains why I’ve read reports on support groups about problems people have had when switching brands.

Combining Prozac (fluoxetine hydrochloride) and lithium can cause unpredictable serum levels.  Be sure to have regular level checks if mixing the two.

The same applies if you combine lithium with Topamax (topiramate).  A study referenced in “Topiramate:  drug interactions”  by Barry E. Gidal PharmD Antiepileptic Drugs has Topamax lowering lithium levels 11% to 16%.  Yet a case report has them being raised, and that’s what made it into the Drug-Drug Interactions checker.  So get those levels tested if you insist on adding Topamax for weight loss.

The way lithium works in your brain can wind up canceling the effects of some blood pressure medications.  Or the other way around.  So if you’re taking blood pressure meds that work on sodium channels, lithium may not be for you.

You really do need to drink between 2.5 and 3 quarts/liters of water a day when taking lithium.  That’s on top of whatever other fluids you might like to consume.  Lithium isn’t really metabolized, it petty much hits your brain as is and is then flushed out of your system, mainly via your kidneys.  A lot of the problems people have with lithium stem from used lithium hanging around the exit.

 Lithium’s Dosage and How to Take Lithium: For bipolar disorder the lithium meds are all about your blood serum levels.  The sweet spot is somewhere between 0.6 and 1.2.  Good doctors will take into consideration your age, weight, previous history with medications (if any), and just how freakin’ manic you are at the time to determine where to start you.  Lazy doctors will start you at 900mg a day if you’re mildly crazy and 1800mg a day if you’re climbing the walls.

Unless you or your family member has utterly lost it with mania, I’m for starting out at 450mg a day for controlled-release versions (Eskalith CR, Lithobid, Duralith, etc.), 300mg a day for immediate release.  That is highly unlikely to get you near the therapeutic level of 0.6, but it does allow you to acclimate to the lithium.  After a week you get a blood level and you see where you need to go. Probably up, but you never know.  Mouse would get lithium toxicity above 100mg a day.  One week at 300mg a day was enough to give me 12 years worth of tonic-clonic seizures.  Granted we are autistic-bipolar-epileptic freaks of the first water, and while anything is possible in the world of psychiatric medications, it is highly unlikely lithium will hit you as badly unless you are also an autistic-bipolar-epileptic freak.
Days to Reach a Steady State: Usually a week, but there are far too many variables involved with lithium.

When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Lithium Takes to Work: First you have to reach the therapeutic range of 0.6 to 1.2. Then you have to find where in that range you have the best results, which can vary throughout the year along with other factors in our life. Then you have to give it a couple weeks after that. It can literally take a couple years to figure out if lithium is going to be the drug for you or not.

Lithium’s Half-Life: An average of 24 hours for the controlled-release versions (Eskalith CR, Lithobid, Duralith etc.), somewhat less for the immediate release, but call it a day anyway.

Average Time for Lithium Clear Out of Your System: Lithium is out of your system in about five days.

How to Stop Taking Lithium: Your doctor should be recommending that you reduce your dosage by 300mg a day every five to six days, based on the 24 hour half-life, if not more slowly than that. To make everyone’s life easier it might just be rounded up to a week and you may or may not have a blood level done for shits and grins during the process. For more information, please see the page on how to safely stop taking these crazy meds.

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

How Does Lithium Work In Your Brain: Good question! For a medication that has been used for as long as lithium has, how it works shouldn’t be as much of a mystery as it is.

According to Dr. Stephen Stahl in his Essential Psychopharmacology of Depression and Bipolar Disorder, lithium controls bipolar mood swings and helps with unipolar depression by modulating the G proteins in the phosphatidylinositol system, modulating the protein kinase, or by inhibiting the enzyme inositol monophosphatase.

However, another psychopharmacological hero of ours, Dr. Husseini Manji, has done a bunch more research subsequent to that, and pretty much shot those hypotheses down. His take on it is that it’s all about PKC signaling pathways and the inhibition of PKC isozymes. And the only meds currently on the market known to do that sort of thing are the valproates (Depakote, valproic acid, and whatever they call sodium valproate where you live) and, of all things, tamoxifen.

Chances Lithium Will Work and How It Compares to Other Meds: Dr. Stephen Stahl in his Essential Psychopharmacology of Depression and Bipolar Disorder, gives some pretty hard numbers: 40% to 50% of people who take lithium for bipolar disorder should expect to have positive results. Presuming the side effects are bearable. This is in line with what I read on various support groups. Lithium would likely be more successful if more people would quit whining about gaining ten pounds, thinning hair, or acne and demand miracle drugs for bipolar disorder with no side effects.

That, and get regular checks of their lithium levels to make sure something isn’t seriously wrong. Gaining ten pounds – deal with it. Lithium toxicity – serious side effect. Learn to tell the difference.

As for how lithium compares with other meds, there are so many studies on this it’ll have to wait for this page to get a makeover.

Comments: The first, least expensive and gold standard of mood stabilizers. Lithium has been in use since the early 1800s, has been used to treat psychiatric ailments since the 1880s, and was first used for manic-depression in 1947, and approved by the FDA to treat bipolar disorder in 1970, thus the first of the many off-label meds used to treat bipolar disorder. Although often described as the first mood stabilizer, I think that Thorazine (chlorpromazine hydrochloride) may actually have been approved to treat bipolar disorder first.
Lithium’s long-term effects are very well documented. Along with Lamictal (lamotrigine) it is the only FDA-approved mood stabilizer proven to work for bipolar depression. Symbyax, we note, is an antidepressant specifically formulated for bipolar depression.

Originally I was going to have separate entries for the different brands, but after looking at the anecdotal evidence, there wasn’t much point. While Lithobid may be better on one person’s tummy than Eskalith-CR, that’s an uncommon situation. Lithium is basically lithium.

Lithium is all about blood serum levels. The therapeutic level of lithium is somewhere between 0.6 and 1.2, and that can vary not only person to person but also depending on factors in each individual’s life, such as various stresses and even the season of the year. Doctors are usually pretty good about taking into account things like age and weight and how manic or depressed you are to start you out on lithium, but there’s really no way to tell what your kidneys and thyroid are going to do about it until the lithium hits your system. So while the therapeutic sweet spot is somewhere between 0.6 and 1.2, if you’re especially sensitive to it, lithium toxicity can hit between 1.0 and 1.5! That means you can be fine and stable one day at 1.1 and wake up the next day with nausea, diarrhea, dizziness and the well-known lithium shakes. Conversely you might be fine on 900 mg of Lithobid between October and April, but come May you’ll have to up it to 1,200 mg a day, just to maintain that 0.8 serum level.

Yeah, regular blood tests are part of the lithium drill. Lithium toxicity can happen at any dosage of lithium, because it all depends on how you process the lithium. Because it is processed by your kidneys you need to drink even more water than the extra water we recommend for all psychiatric drugs. Lithium is tough on your kidneys and thyroid. As long as you keep drinking water and have your serum levels checked, your kidneys are covered. Regular tests are needed to make sure your thyroid isn’t getting bent out of shape.
I found out the hard way I was epileptic after starting on lithium carbonate, and was subject to rib-cracking, concussion-inducing tonic-clonic seizures for quite some time. Even though I was tested for epilepsy prior to beginning lithium treatment, but that was on rather primitive equipment back in Australia in 1985. Still, it was bad enough for me to eschew all forms of treatment for years, and then to seek treatment intermittently only for my deepest depressions. Kids, don’t be like me. If one med doesn’t work, try something else. I barely got out of my anti-med madness alive.

Other Brand Names: Camcolit (Bahamas; Bahrain; Barbados; Belgium; Belize; Benin; Bermuda; Burkina Faso; Curacao; Cyprus; Egypt;  Ethiopia; Gambia; Ghana; Guinea; Guyana; Hong Kong; Iran; Iraq; Ireland; Ivory Coast; Jamaica; Jordan; Kenya; Kuwait; Lebanon; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Dutch Antilles; Netherlands; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Singapore; South Africa; Sudan; Surinam; Syria; Taiwan; Tanzania; Trinidad; Tunisia; Uganda; United Arab Emirates; United Kingdom, Zambia; Zimbabwe)
Carbolit (Colombia; Mexico)
Carbolith (Canada)
Ceglution (Argentina)
Ceglution 300 (Ecuador)
Duralith (Canada)
Hynorex Retard (Germany; Switzerland)
Lentolith (South Africa)
Licab (India)
Licarb (Thailand)
Licarbium (Israel)
Lidin (Taiwan)
Limas (Japan)
Liskonum (Bahrain; Benin; Burkina Faso; Cyprus; Egypt; Ethiopia; Gambia; Ghana; Guinea; Iran; Iraq; Ivory Coast; Jordan; Kenya; Kuwait; Lebanon; Liberia; Libya; Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; United Kingdom, Zambia; Zimbabwe)
Litheum 300 (Mexico)
Lithicarb (Australia; Malaysia; New Zealand)
Lithionate (Taiwan)
Lithocap (India)
Litilent (Argentina)
Litocarb (Peru)
Maniprex (Belgium)
Phanate (Thailand)
Plenur (Spain)
Priadel (Belgium; England; Netherlands; New Zealand; Singapore)
Priadel Retard (Greece; Switzerland)
Quilonium-R (Philippines)
Quilonorm Retardtabletten (Switzerland)
Quilonum Retard (Czech Republic; Germany; South Africa, Ukraine, , Luxembourg)
Quilonum SR (Australia)
Teralithe (France)
Theralite (Colombia)

 

 

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