Medication Explained: Lithium Carbonate 💊

What is it?

Lithium carbonate is an inorganic compound, the lithium salt of carbonate with the formula Li2CO3. This white salt is widely used in the processing of metal oxides. It is listed on the World Health Organization’s List of Essential Medicines because it can be used as a treatment for mood disorders such as Bipolar Disorder.

Discovery

Some 70 years ago, John Cade, an Australian psychiatrist, discovered a medication for bipolar disorder that helped many patients to regain stability swiftly. Lithium is now the standard treatment for the condition, and one of the most consistently effective medicines in psychiatry. But its rise was riddled with obstacles. The intertwined story of Cade and his momentous finding is told in Lithium, a compelling book by US psychiatrist Walter Brown. Cade was a POW during World War II and after observing his fellow captives he saw a common trait that he was able to base his own knowledge and experience on, to unlock the door that has been the biggest advancement in Bipolar history. Amazingly too, he conducted his experiments in an old, disused kitchen in his native Australia. If you want to learn more about John Cade, in addition to the book previously mentioned, I highly recommend Finding Sanity. Link is below;

Finding Sanity: John Cade, Lithium and the Taming of Bipolar https://www.amazon.co.uk/dp/1760113700/ref=cm_sw_r_cp_api_i_G9P0M5YZ2BM3TKEJMVAZ

Mode of Action

Lithium is an element in the same group of the Periodic Table as Sodium. The ubiquitous nature of Sodium in the human body, involvement in a wide range of biological reactions and processes and the potential for Lithium to alter these have made it extremely difficult to ascertain the key mechanisms of action in Lithium regulating moods and behaviours.

The answer at the present moment is that we simply don’t know how it actually works. The most recent prognosis is that Lithium may have neuroprotective effects that preserve the functions of neurones and neuronal circuits. Also Lithium promotes the creation of new neurones in the hippocampus which is important for learning, memory and stress response.

Bipolar Disorder has previously been linked to the development of Dementia in later life. Recent meta-analysis of Lithium in animal studies however, has produced some promising results. The results indicated that Lithium may prevent the transition to Dementia. Notably though, both reversible and irreversible neurotoxicity related to Lithium are recognised adverse effects.

Common side effects

  • Headache
  • Nausea or vomiting
  • Diarrhea
  • Dizziness or drowsiness
  • Changes in appetite
  • Hand tremors
  • Dry mouth
  • Increased thirst
  • Increased urination
  • Thinning of hair or hair loss
  • Acne-like rash

Rare/serious side effects

Signs of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, vision changes, and unsteadiness while standing or walking. These symptoms need to be addressed immediately with a medical doctor to ensure your lithium level is not dangerously high.

In rare cases, lithium may lead to a reversible condition known as diabetes insipidus. If this occurs you would notice a significant increase in thirst and how much fluid you drink and how much you urinate. Talk to your doctor if you notice you are urinating more frequently than usual.

Are There Any Risks For Taking Lithium For Long Periods Of Time?

Hypothyroidism (low levels of thyroid hormone) may occur with long-term lithium use.

Rare kidney problems have been associated with long-term use of lithium. The risk increases with high levels of lithium. Your doctor will monitor your kidney function at routine check-ups to ensure this does not occur.

What Other Medications May Interact With Lithium?

The following medications can increase the levels and effects of lithium:

  • Diuretics, such as: hydrochlorothiazide (Microzide®), furosemide (Lasix®), bumetanide (Bumex®), torsemide (Demadex®), acetazolamide (Diamox®), chlorthiazide (Diuril®), and chlorthalidone (Thalitone®)
  • Non-steroidal anti-inflammatory medications (NSAIDs) including: Ibuprofen (Advil®, Motrin®), naproxen (Naprosyn®), celecoxib (Celebrex®), diclofenac (Voltaren®), and nabumetone (Relafen®)
  • Certain blood pressure medications, called angiotensin receptor blockers or angiotensin converting enzyme inhibitors.
    • Angiotensin receptor blockers (ARBs): valsartan (Diovan®), olmesartan (Benicar®), candesartan (Atacand®), losartan (Cozaar®)
    • Angiotensin converting enzyme (ACE) inhibitors: enalapril (Vasotec®), captopril (Capoten®), benazepril (Lotensin®), fosinopril (Monopril®)
  • Certain antidepressants, known as monoamine oxidase inhibitors (MAOIs). Examples include phenelzine (Nardil®), tranylcypromine (Parnate®), selegiline (Eldepryl®, Emsam®), and isocarboxazid (Marplan®)

The following medications may decrease the levels and effect of lithium:

  • Caffeine
  • Sodium chloride (table salt)
  • A medication used to treat breathing problems called theophylline (Theo–Dur®, Slo–Bid®)

My Personal Experience with Lithium

I commenced with my treatment on 11th February 2022. I’m glad I did and I’m in a very, very content place at the moment. The best I have been for a long time. I have started to get a routine in place for the first time in as long as I can remember. There’s still a lot of things that I need to do but I’m on the right track with it. I’ve made enquiries about a few guitar lessons to make me pick it up again and blow away the cobwebs. I’ve stopped drinking alcohol and I’m on orange and soda now. To be honest though, I wasn’t a big drinker anyway. I drank shandy’s and only at weekends. Started back with my language learning, Portuguese and Spanish, because it is so easy to forget what you once knew. Got myself some clothes and donated the stuff I didn’t wear to the charity shop. I’ve also been trying to eat healthy foods. I’ve not quite figured this one out yet as I’m still putting weight on every week. I’m bloody sure it’s the bathroom scales!

I take 3 other psych meds, Depakote (1,500mg), Quetiapine (350mg) and Mirtazapine (15mg). I’m also on Ramipril so there’s concerns for that raising lithium levels in the blood and causing toxicity. However, as I was already on the ramipril, the introduction of lithium could be boosted by it, meaning that I may only need a lower dose than usual to hit the therapeutic zone.

I take my full dose at night and try to take it at the same time each day. I started with 200mg, then up to 400mg and now I have 600mg. When you first begin with your Lithium Therapy, you have to attend a weekly blood test, along with a check on your blood pressure and your weight. As said before I put weight on after cutting all the shite out of my diet. I have levelled out now and I feel comfortable with my weight. I’ve still got a bit of a middle age spread but I’m nearly 40 so I can’t expect to have a metabolism like a teenager. You have to attend weekly appointments until your results show you are in the therapeutic zone and you aren’t in danger of toxicity. The therapeutic zone is 0.4-1.0 mol/I. I’m now on 3 monthly appointments. My own personal opinion is that I’d prefer to have weekly appointments. It not only checks your vitals but it’s also a chance to check in with your Health Team and talk. A problem you have on a Wednesday isn’t necessarily the same problem you have on following Wednesday or the date you manage to get an appointment. That’s the problem with Severe Mental Illness, there’s no manual on how to do a quick fix. I have been to the Pharmacist before while awaiting my appointment with the Psychiatrist and they aren’t allowed to advise. Now if I had a headache then they could. This highlights the most important issue in the UK regarding Mental Illnesses. The service is understaffed and overrun and needs the British government to address the problem.

What Does the Future Hold?

I don’t have the answer to this. Nobody does. For me though, I can at least predict what I hope it brings. I’m doing my own research on Bipolar Disorder and especially with the medication used. I’m not going to be a voice to be heard with my findings, but my understanding is that I am educated to university level in Applied Chemistry with Medicinal Chemistry and I have a passion for medicine and how it works. Also, I’m living with Bipolar Disorder. Forget being educated in bipolar, I am a living embodiment of it. I have started my research looking at the medication used for specific illnesses and then worked backwards to see the medications mode of action. Most of the examples I have looked at so far have been consistent with the fact that they have an issue further down the chemical process chain. So they are not treating the issue at source, merely masking it. This is the same for Bipolar Disorder. So if it’s a common problem, looking at a different example and getting a different perspective could open the doors for a whole host of advancements.

Published by Rochdalestu

I’m a 38 year old male who has recently been diagnosed with bipolar disorder. I have found it as a new chapter in my life that has opened my eyes to a whole new perspective on myself and everything around me.

2 thoughts on “Medication Explained: Lithium Carbonate 💊

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