by Nicole Evans M.D.

Created on: May 05, 2010

Individuals with manic depression are often prescribed lithium as a first line treatment.  The specific FDA approved indication for lithium is as a maintenance medication for preventing or diminishing the intensity of future manic episodes in people with manic-depression, also known as bipolar type I disorder. 

There is only one brand name of lithium in the United States, Lithobid®.  However, there are numerous Canadian brand names including: Apo-Lithium® Carbonate; Apo-Lithium® Carbonate SR; Carbolith™; Duralith®; Euro-Lithium; Lithane™; PMS-Lithium Carbonate; and PMS-Lithium Citrate.

Lithium is associated with numerous adverse effects, some of which are potentially lethal if left untreated.  Individuals who are taking lithium for any reason need to understand the signs and symptoms of these dangerous side effects. Additionally, patients on lithium should always follow the dosage instructions precisely and take their medication exactly as directed

The major lithium side effects span all systems of the body and include:

*Cardiovascular side effects such as bradycardia (slow heart rate), cardiac arrhythmia, edema (tissue swelling from fluid retention), reversible flattened or inverted T waves on an electrocardiogram or “EKG”, hypotension (low blood pressure), and/or syncope (fainting or temporary loss of consciousness).

*Central nervous system side effects including blackout spells, coma, confusion, dizziness, dystonia (sustained muscular contractions), fatigue, headache, lethargy, pseudotumor cerebri (increased pressure around the brain), psychomotor retardation (slowed and/or minimal movements), restlessness, sedation, seizure, slowed intellectual functioning, slurred speech, stupor, tics, and/or vertigo.

*Dermatologic side effects, particularly dry hair, thinning of hair or alopecia (hair loss), folliculitis (inflammation of the hair follicles), worsening of psoriasis, and/or skin rash.

*Endocrine and metabolic side effects such as euthyroid goiter (thyroid swelling with normal thyroid hormone levels), hypothyroidism, hyperthyroidism, hyperglycemia (high blood sugar), and/or diabetes insipidus (deficiency or insensitivity to antidiuretic hormone).

*Gastrointestinal side effects including polydipsia (excessive drinking), anorexia (lack of appetite), nausea, vomiting, diarrhea, xerostomia (dry mouth), metallic taste in the mouth, weight gain, salivary gland swelling, and/or excessive salivation.

*Genitourinary side effects, for example incontinence, polyuria (frequent urination), glycosuria (glucose in the urine), oliguria (low urine output), and/or albuminuria (albumin in the urine).

*Hematologic side effects consisting primarily of leukocytosis (high white blood cell count).

*Neuromuscular and skeletal side effects such as tremor, ataxia (lack of coordinated movements), involuntary “choreoathetoid” movements, hyperactive deep tendon reflexes, and/or rarely the medical condition myasthenia gravis.

*Ocular side effects including nystagmus (involunatry eye movements), blurred vision, and/or transient scotoma (blind spot).

Patients on lithium may protect their health by understanding the many side effects of this potentially toxic medication.  Individuals with questions or concerns regarding the side effects of lithium should contact their health care provider.

Source: LexiDrugs, LexiComp Online. 2010.

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