JoBlog

If you’ve been prescribed Lithium for depression, then you probably have some preconceptions about it. Some people believe that because it is a natural element, it’s better and safer than other drugs. Others take the opposite view, that if it’s used for Bipolar depression, then it must be more serious than other antidepressants around. Personally, I would not agree with either of these, and it’s worth looking at the facts.

What is Lithium used for?

Lithium is primarily a mood stabiliser, and as such is frequently used with Bipolar cases. It has been used in this way for decades, meaning that a lot is known about its interactions, side effects and so on. In cases of clinical depression it is not used as an antidepressant. It is often used to augment the action of an antidepressant, either because the patient seems non-responsive to antidepressants alone, or because the positive effect of a particular drug does not last long enough. (I’m kind of in both of those cateogories). Its other use in clinical depression is as a preventative measure. After a patient is returned to an acceptable mood, an ongoing treatment with Lithium can help to prevent any future relapses.

Dose

The dosage for Lithium is a bit more complex than for most drugs. Whereas most drugs have a minimum and maximum dosage given in the number of tablets, Lithium is based upon the level in your blood. This is because everyone will remove Lithium from their body at different rates. The target range is between 0.5 and 1.0 although most gp’s prefer it to be at the lower end of the range. As a rough guide, most people are somewhere between 1.5 tablets (600mg) to 2.5 tablets (1000mg).

Lithium Toxicity

One of the reasons Lithium has a bad press, is the toxicity. Basically, if you take too much of it, you’re going to get very ill. This is more of a long term effect, rather than an overdose issue, but it’s still something to watch very carefully. Anything above 1.0 can cause you to start having problems, which is why they test your blood so much. Warning signs are extreme thirst, and a tremor.

Blood Tests

Going on Lithium is going to entail a number of blood tests. There’s no way round it. How many you have to have will depend on the person who is monitoring your treatment. There should be one when you start it, and then weekly until your level is stable (4 weeks or so). Then monthly, and finally 6 monthly. If you’re seeing a gp, expect to increase your dose very slowly, and have a lot of blood tests – they can be pretty jumpy about it all.

Aside from the lithium level tests, they’re going to want to check your electrolites (Kidney function) and your thyroid levels. It is extremely rare for lithium to cause any damage at all to your kidneys, and it only really happens after very prolonged use, e.g. 30 years, so just expect these to come back normal. It’s worth taking more notice of your thyroid ones though, as this does cause problems, and there’s two figures you need to know about.

• T4. Your T4 level is a measure of how much active thyroid hormone you have in your body. You want the level to be between about 11 and 22. Going on Lithium will tend to cause a slight drop in your T4, but anything dramatic can require yet another drug adding, to replace the missing hormone.
• TSH. This stands for Thyroid Stimulating Hormone, and does exactly what it says. This level will rise when you go on Lithium, to try to compensate for the lithium pulling the T4 down. Anything above 5.5 is considered abnormal, but it can rise much higher with no adverse effects being noticed. It is the combination of the two values that tell you how you’re doing.

Side effects

The side effects of Lithium haven’t been too bad in my experience. My thirst has certainly increased, and with each dose change I felt quite unwell for a couple of days. I’ve also had a strange effect, where my eyes flick from side to side out of my control, but this has settled down now I’m on a constant dose.