Bipolar Disorder - When we use Lithium

Lithium is the first recommended treatment for bipolar disorder, but only when you have classic bipolar disorder. Classic bipolar disorder is when you have a clean separation between depressive episodes and manic episodes. I've defined depression and mania in several videos that are grouped into my bipolar disorder playlist.

A clean separation means that when one episode is over, you return to your baseline until the next episode comes. You don't have lingering depression with anxiety mixed in.

Lithium is not a good choice when you have a mixture of mania and depression symptoms happening at the same time. We call this bipolar disorder with mixed features. So you have the hyperarousal of mania where you are sped up, you may be impulsive, using poor judgment, irritable or angry while also having at least 3 depressive symptoms with your mania. I describe this in more detail in my mixed mania video.

In the case of mixed features, the recommended first choice is an antipsychotic medication like quetiapine. We use the second generation antipsychotic medications as mood stabilizers in bipolar disorder.

One thing that lithium does that the other medication don't do as well is it reduces suicidal thinking. The only other medication that addresses this at the same level is ketamine, which we use for treatment resistant unipolar depression.

Side effects of lithium
Lithium can cause weight gain, tiredness, and fuzzy thinking similar to some of the other mood stabilizers. But Lithium also has some side effects that can come with long-term use. Lithium can cause your thyroid to malfunction such that you start to produce inadequate amounts of thyroid hormone.

The second long-term side effects is to your kidneys. Everyone has some decline in kidney function as you get older. But long-term lithium use can accelerate this process. You can also get a condition called diabetes insipidus. This is different from diabetes mellitus where you get elevated blood sugar levels. With insipidus, your kidney loses its ability to concentrate your urine. You get frequent urination and excessive thirst.

Diabetes insipidus can happen even within the first weeks to months of taking lithium. In usually resolves on its own, but it can persist in about 25% of people. Sometimes this problem can be helped by taking your lithium all at once at bedtime. If the problem doesn't go away, then it's probably best to switch to a different mood stabilizer. If you catch it early, it's reversible usually within weeks.

Another way lithium can damage your kidneys is if it gets too concentrated in your blood. It can reach toxic levels and damage your kidneys. That's why it's important to have your lithium levels checked on a regular basis and you have to make sure you stay hydrated. If you loose a lot of fluid from excessive sweating, diarrhea or vomiting, watch carefully for signs of lithium toxicity.
Early signs of lithium toxicity are tremor, slurred speech, feeling tired and weak. You can also get diarrhea and vomiting from the toxicity. If you started feeling this way, you should get yourself to an emergency room or urgent care to be evaluated.

If you are on lithium, make sure all of your doctors know so they can check for any drug interactions from medications they prescribe. Also, if you have pain problems, watch your consumption of non-steroidal anti-inflammatory medications like Advil or Aleve. This class of medication can increase lithium levels.

What about lithium orotate?
This is a version of lithium that is available over the counter. It's a much lower dose of lithium than what you get with prescription lithium. The prescription versions are lithium carbonate and lithium citrate. Because you are still taking lithium, you are still susceptible to the risks that you have with prescription lithium.

Links to videos

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

[emmafredman]

I was on lithium for a year. It saved my life, but the monthly blood tests, the shaky hands, the constant metallic taste, not to mention the weight gain, it made me feel physically crummy. It was worth it, though. I remember the first moments my mood began to lift. It was actually last Christmas. I was sitting in China town and told my family “I finally feel as if going to be okay.” After a year long battle, thanks to lithium. It still brings tears to my eyes. I went off it on labor day and I’ve lost 30 pounds (I’m on lamotrigine) and my Bipolar will never haunt me again. I turn 18 next month. Without lithium, I wouldn’t be having any more birthdays. Funny how you uploaded this today.

[raphaeldantona]

Hi, there. I'm on lithium for about a month now, after being diagnosed with bipolar disorder. I almost shed in tears when you said it adresses suicidal thinking. It's true. One week after starting the medication, I couldn't be happier. All I could think is how my life could have been easier if I had searched proper treatment before.

[madisongoodbody]

I’m 20 and have been on lithium for 2 years. I must have got lucky, because apart from excessive thirst, I’ve had zero side effects! I spent 4 years on anti psychotics that ruined my life with the side effects, so I am so happy to have finally found a medication that has saved my life. I haven’t had an episode in nearly 2 years. There is hope!

[RCPMK]

One thing I gain from reading all the comments is how much of a challenge dr’s must have treating us. The variety of meds, symptoms, and how every person seems to react differently to treatment is fascinating.

Thank you so much for this video ❤️

[gareaibrahim]

I really take advantage of what you share everyday,
Keep it up mrs, Psychiatrist

[Metalbassist]

As someone with bipolar disorder currently prescribed lithium, really glad to see accessible information out there. I greatly appreciate this.

[myfugitivecat]

Other doctors, especially the ones in my country must watch your videos and educate themselves. Not only for the knowledge you present and share but for the honesty and sincerety you possess. You're an awesome human being. Have a nice day and take care :)

[tesoromio]

This video has been so helpful, so as always thank you. My experience with Lithium was horrible at first, I was taking the immediate release capsules and I would start vomiting about a half hour after taking it, in addition, I was constantly urinating-to the point of bed wetting, also I was shaking so bad I couldn't hold a glass of water without it falling to the ground. I asked if there was an extended release that I could try and was switched immediately. My life has changed so drastically for the better. I had to be taken off of my Lisinopril by my cardiologist for drug interaction and once he saw that I was taking Lithium he asked how it was going with the drug and without even thinking I replied "amazing". It has changed my life for the better and I no longer slack on taking my medication because I know that I have finally found a treatment that works. Thank you for your insight on the topic, and please continue making these awesome videos.

[SS-lghq]

I just want to give my experience. I don’t think I have classic bipolar but was probably closest to that when I was younger. I started developing mixed features about 8 years ago when my mom died. At that time I sought treatment for a second time at the request of my primary care. I was put on lamictal, which turned out to be horrible for me. I dropped off medicine for about 18 months. I finally agreed to give Lithium a try. OMG I can’t believe the difference it has made. My suicidal thinking is gone, my anxiety is not gone but reduced, unfortunately my euphoria is also greatly reduced but it has given me hope for the future. I am sleeping better. I just wanted to give my experience for someone else who may be going through a similar experience.

[noxprsn]

Other tips for lithium survival: Salty foods and beverages, ice water, taking it all at bed time, lab tests every 6 months, taking on a full stomach, taking electrolytes

[neurosophy]

I hope you see this comment, and I will keep it brief. I have primarily the atypical features described in your other video. My two big episodes were both psychotic with mixed features. I do not return to a nice functional baseline between episodes, and I have several comorbid conditions. But lithium works wonders for me; my episodes start to resolve within days, and it's been a very effective maintenance treatment. Anticonvulsants didn't do much at all, and antipsychotics made my symptoms worse. If I'd been trialed on lithium sooner it would have spared me a lot of suffering. You should emphasize that this is a heuristic, not a rule, and it's something to bear in mind in your practice. I tend to think lithium is underutilized and I'm sure there are others like myself who don't fit the classic picture but are nonetheless strong lithium responders, who are effectively being harmed by their medication regimens while they cycle through ineffective drugs when the first-line treatment hasn't been tried.

[thedogroll]

I am a veterinarian with type 2 bipolar, with clear ups and downs. I'm slowly transitioning from sodium valproate to lithium and I'm really appreciating it. Sodium valproate made me feel hazy. Transition is clearing my head.
Diabetes incipidus would be a minor inconvenience.
And I appreciate your response on OTC medications with potentially lethal overdose consequences. We see animals juiced up by their owners on OTC medications to toxic levels commonly. Please always seek PROFESSIONAL advice people. That's why we study and train for so many years.

[jvdtempel]

Great series on bipolar! Would be great to see a video discussing hyperreligiosity and spiritual/religious experience in mania. Not just the phenomenology (which often overlaps with normal spiritual/religious experience, e..g., sense of oneness, synchronicity, divine mission), but also the difficulties of making sense of these experiences after the fact. It can be a lifelong struggle to reconcile having a diagnosis of psychiatric disorder with what are often extremely meaningful and compelling insights gained in these experiences. Integrating them in healthy, adaptive ways (e.g., balancing spiritual and medical appraisals) is a challenge for both clients and practitioners, especially in secular cultures where shared religious beliefs and communities aren't often available or appropriate.

[tealcat]

Lithium orotate is like a mineral supplement. 5mg a day + magnesium really helps calm the nerves and feel grounded. No negative side affects so far for me. Increased apetite, thirst and a bit of nausea maybe, but it helps negate bad thoughts.

[abc_cba]

The best channel I subscribed to in 2020 of the nearly hundreds that I did !
You're such an amazing doctor.

All cheers from India 🇮🇳

[TampaJohn]

I’ve been on Lithium since I was diagnosed with BPD in 2015. I’m so thankful for it. When I was manic, I did some really dangerous and damaging things. When I was depressed, I was suicidal at times. I’ve been hospitalized in a mental institution twice. Since, I have had some “moments”, but nothing even close to the way I was. I do love Advil, so I will have to look into taking something else. Thanks for the info.

[jackcliff]

Thank you so much for making this video. I actually went to counseling today, and she is going to suggest to my APA that I switch to lithium. I subscribed to your channel and plan to keep watching them.

[Andrea-tucn]

Thank you so much for breaking this down for us. I was diagnosed with Bipolar I a year ago and have been trying to pick up the pieces of my life since then. I wish my psychiatrist had the time to explain all of this information before I was put on lithium. He really wanted to take me off of depakote when I got out of the hospital because he just had something against any woman of child bearing age take it. I really wish I had stayed on it now though because I have been realizing that about half of all my mood episodes are mixed. Thank you for such an enlightening video, I plan on bringing up the mixed mood episodes in my next appointment.

[gogoletsgodarling]

I know this video is from 4 years ago but this popped up on my feed as I was explaining why I stay on lithium. My tardive dyskinesia was showing last night so my friend was asking what the benefits were since the side effects can be so severe.

Lithium saved my life.

I love your channel! Not only does it help me understand things but it helps my friends understand me better too.

[jenng]

Thank you for this. I’ve been taking lithium for 13 years. It was the second mood stabilizer my doctor tried and was the best option for me.