Curriculum · Mental Health / Psychiatry
Lithium therapy and its adverse effects
What it is
Lithium is a drug with a narrow therapeutic index and a low volume of distribution. It is one of the mood stabilizing medications used for acute mania, alongside antiepileptics and antipsychotics, and lithium carbonate, valproate or other mood stabilizers are also useful in treating mood swings. In mania lithium is effective but less effective than an antipsychotic, it is difficult to be controlled in severe cases, and it needs days to start to work, so it is useful in mild cases and in preventing relapse. Valproate is slightly less effective than an antipsychotic and is useful in patients who are not currently on a mood stabilizer and in a manic patient without psychosis; its advantage over lithium is that it can be given in a high loading dose for acute illness.
Causes and risk
Elderly patients are more likely to develop lithium toxicity because of their lower muscle mass and age-related decreased glomerular filtration rate. Chronic toxicity is more common than acute toxicity and is often precipitated by events causing volume depletion, such as vomiting, diarrhea, and acute gastroenteritis. Drugs that impact renal function or volume status, such as ACE inhibitors, NSAIDs, and diuretics, can also precipitate toxicity.