Lithium, A Mood Stabilizer
Lithium is an ion: a simple chemical element from the group of alkali metals. It is the lightest solid element of all. It is present in many minerals, seawater, springs, plant and animal tissues, etc.
It was discovered in 1817 and has been used to treat different human conditions, such as gout or psychiatric illnesses. For a long time, it was responsible for many serious poisonings when used as a substitute for other medications for heart disease.
What is lithium used for?
In Spain, lithium carbonate is currently marketed under the name Plenur. It is used as a mood stabilizer or eutimizer. It is indicated in the following cases:
- prophylaxis of bipolar disorder
- treatment of bipolar disorder
- recurrent major depression
It is the treatment of choice for bipolar disorder or manic depression. This disease alternates episodes of extreme euphoria and states of depression that can lead to suicide.
Following a manic episode, there is a 90% chance that the patient will have another similar episode or a depressive episode. Therefore, administering treatment during the episode is considered as important as prophylaxis once the disease is under control.
Lithium is also used in patients with recurrent major depression. In other words, in those who do not show improvement with conventional antidepressants or only partially respond.
Furthermore, lithium chloride is marketed as an injectable solution for diagnostic use for the in vivo determination of cardiac output.
Its mechanism of action
Despite its wide use and proven efficacy, the mechanism of action of lithium is not exactly known. Further investigation is needed.
This ion is rapidly and completely absorbed after oral administration. It is distributed throughout the body and does not bind to plasma proteins. It has a small volume of distribution and is excreted in the urine without being metabolized. Lithium can be removed by dialysis.
Being a monovalent cation, it competes with other ions such as sodium in various places in the body. In the central nervous system (CNS), it appears to inhibit depolarization caused by neurotransmitters :
- There is a hypothesis that lithium decreases the concentrations of cyclic AMP. This would decrease the sensitivity of hormone-sensitive adecylcylase receptors.
- And according to another hypothesis, lithium interferes with the lipid metabolism of inositol, a substance important for the regulation of the metabolic processes of the CNS.
Its side effects
Lithium is a drug with a narrow therapeutic window. In other words, the therapeutic dose and the toxic dose are very close. It is therefore not surprising that side effects frequently appear. For this reason, it is important to assess each case and adjust the dose for each patient.
These side effects are mainly CNS adverse reactions, gastrointestinal and renal reactions. During the first days of treatment, the following symptoms usually appear: mild hand tremors, thirst, polyuria, nausea and general malaise. These symptoms should decrease during the first 10-15 days.
The most common side effects of lithium are:
- Drowsiness
- Tired
- Muscular weakness
- Headache
- Confusion
- Polyuria
- Polydipsia
- Hypercalcemia
- Anorexia
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Constipation
- Hypothyroidism
- Goitre
In patients treated with lithium, blood drug levels should be monitored. The thyroid and renal functions must be particularly controlled.
Also, it is recommended to drink an adequate amount of fluids during the treatment and to avoid possible dehydration situations.
Lithium poisoning
Lithium poisoning can be a common and serious complication if proper measures are not taken. Acute poisoning due to high dose or chronic toxicity may result from continued treatment for several years. This is the most common case.
Also, drug interactions can cause alterations in the lithium level and thus make it toxic. For example, certain diuretics, anti-inflammatories or even antipsychotics influence lithium.
The first manifestations usually appear two hours after ingestion. Nausea, vomiting or diarrhea may occur. Cardiovascular syncope, renal failure, peripheral neuropathy, etc. can also occur.
The most important symptoms of lithium poisoning occur in the CNS:
- Altered consciousness
- Tired
- Apathy
- Disorientation
- Hallucinations
In short, lithium is a fairly effective drug, but to be handled with care. In the event of a significant adverse reaction, a specialist should be consulted promptly. Only the latter can decide to stop treatment, adjust the dose or suggest other alternatives.
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