by Nicole Evans M.D.

Created on: May 05, 2010

Bipolar type I disorder occurs as frequently in men as it does in women.  Type I bipolar disorder is also known as manic-depression.  The gold standard treatment for bipolar disorder is lithium, a prescription medication that is particularly effective in preventing or diminishing the intensity of manic episodes.  However, lithium is associated with numerous side effects that are particularly important to men with bipolar disorder.

Side effects of lithium that impact medical conditions prevalent in men:

* Hypertension: More men than women have hypertension.  Individuals with hypertension may be treated with diuretics and other medications that alter sodium excretion.  These medications include diuretics such as furosemide (Lasix) and hydrochlorothiazide (HCTZ) as well as ACE inhibitors such as Lisinopril or Enalipril.  Lithium must be used with caution in men receiving medications that alter sodium excretion because this can increase lithium toxicity.

* Cardiovascular disease: Heart disease is more prevalent in the male population.  Unfortunately, lithium can cause numerous cardiac side effects and should be used with caution in people who have mild to moderate heart disease.  Potentially dangerous lithium side effects that may occur in people with cardiovascular disease include bradycardia (slow heart rate) and cardiac arrhythmias.

* Genitourinary disease: Benign prostatic hyperplasia or BPH is common in older men.  Along with prostate cancer, BPH often causes urinary symptoms in men.  However, lithium can also cause urinary symptoms that resemble the symptoms of BPH and prostate cancer, for example incontinence, polyuria (frequent urination), and oliguria (low urine output).  An older male with urinary symptoms who is also on lithium should receive a complete work up to determine the true cause.  

* Balding: Many men who experience hair loss or hair thinning may assume it is the result of aging.  However, men who are on lithium may experience dry hair, thinning of hair and/or alopecia (hair loss) as a side effect of their medical therapy.  

* Dehydration: Men are more likely to have jobs that require physical labor and may result in significant fluid losses through sweating.  Prolonged or severe fluid losses can significantly increase the toxicity of lithium.  Thus lithium should be used with caution in men who are engaged in employment that can induce significant insensible fluid losses through sweating.

The side effects of lithium can occur with any of the available formulations. 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.

The vast majority of men with bipolar disorder are treated with lithium.  Men should know that lithium can cause many side effects of great importance to the male sex.  Individuals with questions or concerns regarding their medication should always contact their health care provider.

Source: LexiDrugs, LexiComp Online. 2010.

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