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Among the several available treatments for mania associated with the Bipolar Disorder, none offers a greater likelihood of improvement than lithium. This mood stabilizer often provides significant relief as solo therapy, however many affected individuals will ultimately require several drugs for adequate respose.
More widely prescribed in Europe than the United States, lithium needs between 1-3 weeks to become fully effective. The drug offers its benefits within a relatively narrow therapeutic window with toxic reactions associated with excessive serum concentration. To minimize the potential for harm, mandatory routine blood testing must be performed weekly at the onset of therapy and progressively less frequently over time.
People receiving lithium must remain adequately hydrated. Dehydration even from excessive perspiration or exercise may alter the blood concentration of lithium and precipitate a wide array of adverse reactions.
Side effects range from restlessness and sedation to acne, hand tremor, slurred speech and weakness. Among the peculiar problems associated with lithium are hypothyroidism due to decreased production of the hormone and interference with its conversion into the active form - triiodothryonine. This occurs more often in women than men.
Lithium competes with vasopressin in the kidney. This chemical, also known as anti-diuretic hormone, allows the kidney to reabsorb most of its filtered load and prevent dehydration. Lithium regularly increases urine volume which leads to thirst and dry mouth. Of course the resulting dehydration and blood volume contraction raises the serum lithium levels which in turn multiplies the possibility of other adverse reactions.
Acute toxicity focuses on the gastrointestinal system causing nausea, vomiting and diarrhea. Chronic toxicity tends to involve neurologic symptoms and may originate from causes as diverse as loss of appetite, exercise or food poisoning. Suggestive symptoms include impaired walking ability, poor judgment, altered mental state and difficulty concentrating. Hallucinations, seizures and coma may develop if the warning signs are not appreciated.
In spite of the long list of potential problems, lithium may reduce the incidence of suicide by as much as 40% in those suffering from mania. In this regard, no other medication provides anywhere near the benefit. Surprisingly in those communities where moderate levels of lithium are found in municipal water supplies, studies demonstrate a decreased incidence Alzheimer’s disease, less depression and an elevated mood.