Lithium is a metallic element discovered in 1818. In 1949 John Cade, an Australian psychiatrist, found that it was useful for treating elation or mania and since then it has also been found to be effective in preventing recurring biological mood swings. As a medical treatment lithium is always used in the form of one of its salts, lithium carbonate or lithium citrate. It is the lithium ion which is medically effective.

When is lithium used?
Lithium's has both a preventative and a treatment effect. It is mainly prescribed to prevent recurring bouts of depression and elation. It is used most commonly in bipolar manic depression, that is where there are episodes of ‘highs’ and ‘lows’ separated by periods of normal mood. Recurring bouts of elation, another form of bipolar manic-depression, is also responsive to lithium.

People who have recurring depressions alternating with periods of normal mood are considered to have recurrent unipolar depression. Prevention of these depressions may be achieved with antidepressant medications alone, with lithium or with a combination of lithium and an antidepressant drug.

Lithium is also prescribed to treat acute elation. It tends to bring the patient's mood under control more quickly than other standard treatments and has fewer side effects. More recently lithium has been used in combination with antidepressants to treat depression that has proved resistant to other treatments.

Lithium is a natural element and as such is different to other medical treatments used for mood swings. You cannot become addicted to lithium, or have withdrawal symptoms when it is stopped. If a person begins to feel unwell after stopping lithium, it usually means that some of the mood related symptoms which had been effectively treated by lithium are re-emerging. Lithium does not lose its effect with time.

Does lithium cure mood swings?
No, but it is the most effective way to control them. When lithium is taken to prevent return of mood swings it needs to be continued.

Your doctor will take a detailed history from you and a close relative to assess what type of mood disorder you have, how disruptive an effect it has on your life and whether you are likely to benefit from lithium treatment. Your doctor will also ask you about your general medical history, whether you have had thyroid, kidney or heart disease or suffer from epilepsy. The doctor will also need to know about any medication you are taking, particularly treatment for high blood pressure and water retention or oedema. Be sure to inform your doctor about all tablets, including non-prescription products.

Tests prior to lithium use
Blood tests are required before treatment to assess the state of health of the thyroid gland and kidneys. An over-active or under-active thyroid gland may cause symptoms that resemble elation or depression. Lithium itself may produce under-activity of the thyroid gland. Kidney tests are performed as lithium is eliminated from the body in urine and if this excretory mechanism is not adequate it may not be possible to prescribe lithium.

When lithium tablets are taken by mouth they dissolve into small particles in the stomach and pass into the blood stream. From there they are carried to all parts of the body including the brain. Lithium escapes from the body through the kidneys, into the urine; this filtering process tends to be slow so there is a tendency for lithium to accumulate in the blood stream.

Blood tests show how much lithium remains in the body. A certain level of lithium is necessary to produce mood stability; if a person has a low blood level, they will continue to have mood swings. Also, it is relatively easy to have too much lithium in the body and this will produce unpleasant and sometimes serious toxic effects. Blood tests are necessary for anyone taking lithium.

Your doctor will decide dose based on the type of mood disorder you have and how effective your kidneys are in excreting lithium.

Lithium and side effects
Lithium, like all other treatments, can cause side effects. In general these are related to the level of lithium concentration in the blood. If the lithium level is low and below the therapeutic range you are unlikely to have side effects but you are also unlikely to benefit from the treatment. If your blood lithium concentration is within the therapeutic range you may have mild side effects. Should your level go above the therapeutic range, you can have serious toxic effects.

The more common side effects are mild hand tremor, increased thirst, increased urination and occasionally stomach cramps and nausea.

When lithium is initiated there may be mild weight gain, but this will often either correct itself after the body becomes accustomed to the medication or it can be easily remedied by a formal diet, supervised by your doctor.

Lithium toxicity
Lithium toxicity occurs when the body accumulates excessive lithium so that it retains more lithium than the kidneys can excrete. Initially the patient will experience drowsiness, tiredness, an inability to concentrate, marked hand tremor and nausea. Slurred speech, unsteady gait, vomiting, diarrhoea and confusion will occur as the blood lithium concentration increases. These symptoms should be immediately brought to your doctor's attention as the lithium concentration may continue to rise, causing more serious effects. If a doctor cannot be contacted, you should visit Accident and Emergency Department at the nearest hospital.

The main reasons for lithium toxicity are:
Taking too many lithium tablets.
The loss of salt from the body due to:
Physical illness, especially where there is high fever, nausea, vomiting, diarrhoea or dehydration.
Unsupervised dieting or fasting.
Low salt diets
Diuretics (kidney or water tablets), arthritis pill and some pain relievers.
Excessive exercise, hot weather, excessive perspiration, all resulting in loss of fluid and salt.
Kidney disease - when the kidneys become unable to rid the body of lithium.

Lithium and pregnancy
Women who take lithium during the first three months of pregnancy have an increased risk of giving birth to babies with congenital abnormalities, particularly of the heart and major blood vessels. Women on lithium who would like to start a family should discuss this with their doctor. There are also additional measures which need to be taken for pregnancy women who are recommenced on lithium after the first three months.

As lithium passes into breast milk, a mother will have to choose either to breast-feed and interrupt lithium therapy, or bottle feed, which allows the lithium treatment to continue.

There are no known harmful effects from lithium on the children of fathers who were taking this treatment at the time of conception.

For the majority of people with bipolar mood swings lithium is the most specific and effective treatment. People with unipolar depression are just as likely to show a preventative response with an antidepressant as with lithium. However, not everyone can tolerate lithium and not everyone is helped by it. Alternative treatments are available to help in such instances.

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