Lithium is a salt (lithium carbonate). Anything that lowers the level of sodium in the body may cause a lithium buildup and lead to toxicity. Examples include reduced intake of table salt, a switch to a low-salt diet, heavy sweating from an unusual amount of exercise or a very hot climate, fever, vomiting, or diarrhea. It is important to be aware of conditions that lower sodium or cause dehydration and to tell the doctor if any of these conditions are present so the lithium dose can be changed.
Lithium can have unwanted effects when combined with certain other medications. Some diuretics (which remove water from the body) increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat, and seizures. A lithium overdose can be life-threatening. People who are taking lithium should tell every doctor who is treating them, including dentists, about all medications they are taking.
Lithium is a safe and effective drug for most people who take it. With regular monitoring, people who otherwise would suffer from severe mood swing can lead normal lives.
Anticonvulsants
Many drugs that are used to treat seizures can also be used to stabilize mood. These anticonvulsants are used for people with bipolar disorder who do not benefit from lithium or would prefer to avoid lithium.
Valproic acid (Depakote, divalproex sodium) is the main alternative therapy for bipolar disorder. It is as effective in non-rapid-cycling bipolar disorder as lithium and is probably superior to lithium in rapid-cycling bipolar disorder. Valproic acid can cause gastrointestinal side effects in a few people. Some people also report headache, double vision, dizziness, anxiety, or confusion. Valproic acid has rarely caused liver problems, so liver function tests should be performed before therapy and at frequent intervals afterward, particularly during the first 6 months of therapy. Young females patients should me especially closely monitored.
Other anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). These medications are used more frequently for short-term mania than for long-term maintenance of bipolar disorder. Lamotrigine may be particular effective in bipolar depression.
Many people who have bipolar disorder take more than one medication. Along with the lithium and/or an anticonvulsant they may take a medication for accompanying agitation, anxiety, insomnia, or depression. It is important to keep taking the mood stabilizer when taking an antidepressant because treatment with an antidepressant alone increases the risk that the patient will switch to mania.
Atypical Antipsychotic Medications
Atypical antipsychotic medications are sometimes prescribed for bipolar disorder. They may be used early in treatment to manage mania, or they may be used longer-term.
Whatever treatment is prescribed, it is important to keep taking medications even when the symptoms subside. Patients with bipolar sometimes stop taking their medications because the manic phase of the disorder (the high) feels good. Staying on prescribed medications is the best way to manage the symptoms of bipolar disorder.
