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Lithium carbonate, one of several lithium compounds used as a mood stabilizer for manic depression or bipolar disorder.
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Lithium, in the salt family, is also a powerful mood altering drug. While a naturally occurring compound, when used as a mood stabilizer, it can have strong and multiple side effects.
Regular blood testing is necessary when taking lithium and the levels of the drug need to be closely monitored. It is used in treating bipolar disorder and some severe
depressions, although it's effectiveness is said to be very variable in treating depressions.
Uses of mood stabilizers: Mania and hypomania. (Hypomania-close to mania).
The first mood stabilizer to be used was lithium, and it is the only drug that was developed specifically for use in bipolar disorder. It was first approved for use in treating mood swings by the FDA in the 1970s.
Most the other drugs classified as mood stabilizers are medications that were first used to treat seizure disorders, such as
epilepsy. They are known as
"anticonvulsants," since they are designed to inhibit or reduce the frequency of seizures. Interestingly, they also help stabilize mood swings.
Some heart-related medications called
calcium channel blockers are being studied for use in treating
bipolar disorder as mood stabilizers.
Bipolar disorder treatment, commonly includes mood stabilizers.
Antipsychotics and
antidepressants are also sometimes used along with a mood stabilizer.
Commonly Used Mood Stabilizers
Generic name: carbamazepine
Trade name Tegretol
Generic: valporate
Trade name: Depakote
Mood Stabilizers uses and side effects: Bipolar disorder, especially manic episodes. Tegretol-neurotoxic side effects have been noted, including unsteady gait, tremor, ataxia, and increased restlessness.
Depakote: fewer side effects than lithium, but can be sedating. Depakote is used much more frequently than lithium today, however, it carries a 2-3x higher risk of suicidality than lithium.
Lithium - Side Effects
Lithium, a mainstay in the treatment of bipolar disorder, has been reported to induce adverse effects in 35%?93% of patients who take it, and these adverse events often lead to noncompliance.
The side effects most frequently reported were:
Polyuria-polydipsia syndrome, which affected 36 (60%) of 60 patients.
Tremor (54% men v. 26% women, p < 0.05)
Weight gain during the first year (47% women v. 18% men, p < 0.05)
Clinical hypothyroidism (37% women v. 9% men, p < 0.05)
Source: Journal of Psychiatry and Neuroscience. 2002.
Other "real life" side effects for lithium are reported from numerous sources as follows:
slow verbalization
feeling somewhat "detached"
feeling detached from my own voice
emotionally detached
not feeling yourself
tiredness
tremors
lithium [emotional] flatness
The publication, Mental Health Medications (off-site link), by the National Institute of Mental Health, U.S. Department of Human Health Services, lists the following side effects for lithium treatment for bipolar disorder, stating,
Lithium can cause several side effects, and some of
them may become serious. They include:
Loss of coordination
Excessive thirst
Frequent urination
Blackouts
Seizures
Slurred speech
Fast, slow, irregular, or pounding heartbeat
Hallucinations (seeing things or hearing
voices that do not exist)
Changes in vision
Itching, rash
Swelling of the eyes, face, lips, tongue,
throat, hands, feet, ankles, or lower legs.
Side effects for lithium are usually more intense in the first months and gradually improve slightly, although, persons who have been on lithium for many years, still describe some of the emotional detachment and other side effects listed here.
Notes on lithium side effects from Depression Forum:
"....i was wondering as it's a mood stabilizer, if it blunts higher levels of mood...?...i don't ever get excited or highly aroused etc."
"...my emotions were flat ALL the time. I hated that. It did stabilize me and I thank God for that but I wanted to feel a little too." L. (www.depressionforums.org)
Additional side effects or complications with lithium use
"Lithium has been associated with birth defects."
Stopping after finding out one is pregnant "may be too late to prevent a birth defect." (Mondimore, p.91).
"A noticeable dulling of mental functioning and coordination," is listed as a major side effect. (Ibid, p. 92).
"Patients often complain that their ability to memorize and learn is affected and that they have a difficult-to explain sense of mental sluggishness."(Ibid, p. 92).
From book:
Bipolar - A Guide for Patients and Families by Francis Mondimore.
Additional Professional References and Clinical Studies on Lithium Treatment
The following sampling of selected professional references and clinical studies concerning lithium provide a view of the side effects and complications, as well as the frequency with which they occur.
1. Despite methodological flaws, poor replicability and the subtle cognitive effects of lithium, five consistent findings emerged from the review; impairment on tasks of psychomotor speed, impaired functioning in the majority of studies examining verbal memory, no impairment on tasks of visuo-spatial constructional ability or attention/ concentration, and no negative cumulative effect.
CONCLUSIONS:
Many patients administered lithium carbonate complained of mental slowness. Lithium carbonate also appeared to have definite, yet subtle, negative effects on psychomotor speed. Studies reviewed also showed a trend toward impaired verbal memory. Recommendations with respect to future research, methodological and statistical problems, and additional clinical implications are presented.
The effects of lithium on cognition: an updated review. by A.K. Pachet, A.M. Wisniewski.
Source: Brain Injury Program, Columbia Health Centre, Calgary, Alberta, Canada
https://www.ncbi.nlm.nih.gov/pubmed/14504681
2. The therapeutic use of lithium carbonate may produce unusual toxic responses. These include neuromuscular changes (tremor, muscle hyperirritability, and ataxia), central nervous system changes (blackout spells, epileptic seizures, slurred speech, coma, psychosomatic retardation, and increased thirst), cardiovascular changes (cardiac arrhythmia, hypertension, and circulatory collapse), GI changes (anorexia, nausea, and vomiting) and renal damage (albuminuria and glycosuria). The last is believed to be due to temporary hypokalemic nephritis. Long-term sequelae from acute lithium poisoning include cognitive losses such as impaired memory, attention and executive functions and visuospatial deficits.
Klaassen, C.D. (ed). Casarett and Doull's Toxicology.
The Basic Science of Poisons. 6th ed. New York, NY: McGraw-Hill, 2001., p. 852 **PEER REVIEWED**
3. Seizures have been reported in nonepileptic patients with plasma concn of Li+ in the therapeutic range. Myasthenia gravis may worsen during treatment with Li+.
Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman.
Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 510 **PEER REVIEWED**
4. Discontinuation of maintenance treatment with Li+ carries a high risk of early recurrences and of suicidal behavior over a period of several mo, even if the treatment has been successful for several yr; recurrence is much more rapid than is predicted by the natural history of untreated bipolar disorder, in which cycle lengths average about 1 yr. This risk probably can be moderated by slowing the gradual removal of Li+ when that is medically feasible ...
Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman.
Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill, 2001., p. 512 **PEER REVIEWED**
5. Patients suffering from unipolar and bipolar affective illness, who began treatment with prophylactic lithium carbonate during a 5-year period, were followed up and 59 out of 101 interviewed. Most had been taking lithium for at least 13 years: 49% had a complete remission, 41% a partial but significant response, and 10% no response. No specific individual or illness factor was found to correlate with favorable outcome, and no correlation between average serum lithium level and outcome. No side-effects could be associated specifically with the long-term use of lithium, but there was a surprisingly high incidence of clinical hypothyroidism.
Page, C. et al; Br. J.
Psychiatry 150: 175-9 (1987) **PEER REVIEWED** PubMed Abstract
Source 2. - 5. (above):
Lithium Carbonate. (2007, May 14). TOXNET Toxicology Data Network. https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+3351
Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview. 2012, August.
Wiley.
https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2012.01910.x/full
(bold, drug trade names and uses added)
Results: Despite methodological flaws in the older studies and insufficient research concerning the newer agents, some consistent findings emerged from the review;
lithium appears to have definite, yet subtle, negative effects on psychomotor speed and verbal memory.
Among the
newer anticonvulsants, lamotrigine (Lamictal) appears to have a better cognitive profile than carbamazepine (Tegretol - used for epilepsy and BD), valproate (epilepsy and BD)(U.S. - Depakene, Depakon, Depakote-sodium valproate and valproic acid}, topiramate (Topamax) (epilepsy, bipolar disorder), and zonisamide (Zonegran).
More long-term studies are needed to better understand the impact of atypical antipsychotics on BD patients' neurocognitive functioning, both in monotherapy and in association with other drugs. Other agents, like antidepressants and cognitive enhancers, have not been adequately studied in BD so far.
Clinical study: zonisamide (Zonegran) for Bipolar Disorder - "There were no statistically significant differences for any of the primary or secondary outcome measures between zonisamide and placebo-treated patients."
Dauphinais, D, Knable, M, Rosenthal, J, Polanski, M. (2011).
Zonisamide for bipolar disorder, mania or mixed states: a randomized, double blind, placebo-controlled adjunctive trial. Psychopharmacoly Bulletin. 2011;44(1):5-17.
https://www.ncbi.nlm.nih.gov/pubmed/22506436
References for Mood Stabilizers and Lithium page
1.
Lithium Carbonate. (2007, May 14). TOXNET Toxicology Data Network. https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+3351
2. Lithium side-effects and predictors of hypothyroidism in patients with bipolar disorder: sex differences>. (2002, March 27). Chantal Henry Journal of Psychiatry and Neuroscience.
Service Universitaire de Psychiatrie, CH Charles Perrens and INSERM U-394, Neurobiologie Integrative, Bordeaux, France.
https://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=161639
3.
Mental Health Medications (off-site link), (2008).
National Institute of Mental Health, U.S. Department of Human Health Services.
4. Mondimore, Francis Mark, M.D., (2006). Bipolar - A Guide for Patients and Families 2nd Edition. Baltimore:
The John Hopkins University Press.
5. Read, K., Purse, M. Speaking from Experience - Lithium. (2006, June 18). About.com.
https://bipolar.about.com/cs/experience/a/sfe_lithgensfx.htm
Pages Related to Mood Stabilizing Drugs or Issues in Psychiatry
Psychiatric Drugs-Types
Psychology History -
Moral Management: Successful non-pharmaceutical holistic treatment for mental heath in the 1800's.
Positive Psychology Movement - Penn State University
Appeal to
Mental Health Professionals for professional non-pharmaceutical treatment options and clinical studies
Bioecological Model of mental health
NAMI -
Mental Health Disorder Recovery
The
Medical Model of mental health.
Psychiatric labeling and what can be done to prevent
stigma of mental illness.
