by Nicole Evans M.D.

Created on: May 05, 2010   Last Updated: May 11, 2010

Each year more women than men are diagnosed with bipolar type II disorder.  Though bipolar type I disorder occurs equally in men and women, a particularly severe form of bipolar I disorder known as “rapid-cycling” (4 or more manic episodes a year) is more common in women than in men.  Thus the majority of patients on lithium, the gold standard treatment for bipolar disorder, are also women. 

Lithium can, unfortunately, cause numerous side effects in patients with bipolar (also called manic depression).  Lithium is said to have a low therapeutic index, meaning that the levels at which it is therapeutic are close to the levels at which lithium causes toxic effects.  As a potentially lethal medication, lithium requires frequent blood tests and monitoring.

Some lithium side effects are concerning for both women and men, such as seizures, cardiac arrhythmias, weight gain, diabetes insipidus, hair loss, swelling, and coma.  

Other adverse effects and contraindications of lithium are particularly important for women to be aware of. These include concerns regarding pregnancy, breast feeding, thyroid function and central nervous system side effects.

Thyroid effects:

Thyroid disease is much more common in females than in males.  Lithium should be used with caution in women with thyroid disease. Adverse effects on the thyroid that have been seen in women include euthyroid goiter (thyroid swelling with normal thyroid hormone levels), hypothyroidism and hyperthyroidism.

Central nervous system effects:

Lithium can cause a particular side effect in the central nervous system known as pseudotumor cerebri.  This condition is created by increased pressure around the brain, known as intracranial hypertension. 

Pseudotumor cerebri is significantly more common in women, particularly obese women on oral contraceptives (birth control pills).  Thus women who are also on lithium should be aware of the signs and symptoms of this medical condition.

Pregnancy:

Lithium is considered a schedule D drug for pregnant women because lithium can cause congenital malformations.  During the first trimester of pregnancy, cardiac malformations, including Ebstein's anomaly, can occur in the infant. In addition, lithium can cause effects in the newborn infant immediately before and after birth when used near full term. 

These negative effects include shallow breathing, muscular floppiness known as hypotonia, lethargy, cyanosis

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