Long-Term Lithium Therapy: Side Effects and Interactions

Abstract

Lithium remains the drug of first choice for prophylactic treatment of bipolar disorder, preventing the recurrences of manic and depressive episodes. The longitudinal experiences with lithium administration greatly exceed those with other mood stabilizers. Among the adverse side effects of lithium, renal, gastrointestinal, neurological, thyroid, metabolic, cognitive, dermatological, cardiologic, and sexual are listed. Probably, the most important negative effect of lithium, occurring mostly after 10–20 years of its administration, is interstitial nephropathy. Beneficial side-effects of long-term lithium therapy also occur such as anti-suicidal, antiviral, and anti-dementia ones. Pharmacokinetic and pharmacodynamic interactions of lithium, mostly those with other drugs, may have an impact on the success of long-term lithium treatment. This paper makes the narrative updated review of lithium-induced side-effects and interactions that may influence its prophylactic effect in bipolar disorder. Their description, mechanisms, and management strategies are provided. The papers appearing in recent years focused mainly on the long-term lithium treatment are reviewed in detail, including recent research performed at Department of Psychiatry, Poznan University of Medical Sciences, Poland. Their own observations on ultra-long lithium treatment of patients with bipolar disorder are also presented. The review can help psychiatrists to perform a successful lithium prophylaxis in bipolar patients.

Chronic Lithium Toxicity in Old Age Patients Taking Angiotensin Receptor Blocker: A Case Report

“…Lithium therapy is the first choice of drug for the prophylactic treatment and management of recurrent bipolar illness, and manic and depressive episodes. 2 , 3 At a neuronal level, lithium decreases the excitatory but increases inhibitory neurotransmitters; however, multiple complex involvements of neurotransmitters are involved to achieve homeostasis. 4 The incidence of lithium toxicity based on a cohort study was found to be 0.01 per patient-year.…”

Transcranial Magnetic Stimulation in Bipolar II Disorder Treatment: A Case Report

“…Traditional pharmacotherapy for bipolar disorder typically involves the use of mood stabilizers, antipsychotics, and antidepressants, which can be effective in controlling symptoms but may have significant side effects [ 15 ]. Mood stabilizers such as lithium can cause side effects such as tremors, weight gain, and kidney damage, while antipsychotics may cause side effects such as sedation, weight gain, and movement disorders [ 16 ]. Antidepressants can also cause side effects such as insomnia, sexual dysfunction, and suicidal thoughts [ 15 ].…”

“…This region plays a role in the regulation of emotional control. Clinical evidence is building and suggests that TMS can be both efficacious and safe in the reduction of depressive symptomatology in bipolar II [ 16 ]. The ability to target specific areas of the brain with TMS makes it a promising option for the treatment of a range of mental illnesses and disorders [ 16 ].…”

“…Long-term lithium use can cause adverse effects, including but not limited to polyuria, nephropathy, tremor, extrapyramidal symptoms, lithium intoxication, hypothyroidism, goiter, weight gain, hypercalcemia, hyperparathyroidism, and electrocardiogram T wave inversion [ 15 ]. Patients undergoing lithium maintenance therapy are encouraged to test urea, electrolytes including calcium, creatinine, parathyroid hormone, and lithium levels every three to six months [ 16 ]. TMS treatment is utilized after attempting multiple other medications for management.…”

“…TMS treatment is utilized after attempting multiple other medications for management. Clinical trials of TMS for bipolar disorder treatment primarily suggest benefits of depressive symptomatology in bipolar II, with mixed results of manic symptoms [ 16 ].…”