Lithium

Lithium is an active ingredient used to treat manic episodes in bipolar disorder. Lithium is found in medications in various forms, but mostly in the form of lithium carbonate, lithium citrate, lithium sulfate, or lithium acetate. It belongs to the group of antipsychotics and mood stabilizers. Lithium carbonate exists as a white powder. Lithium belongs to the alkali metals in the periodic table (PSE) and has the atomic number 3. Lithium is a light metal and can be found in the 2nd period of the PSE.

Lithium is used in the treatment of psychiatric disorders - first and foremost bipolar disorder . As a mood stabilizer, it can be used to treat both mania and depression.

Unlike other psychotropic drugs, lithium elicits no effect in healthy people. Lithium can also be used to enhance antidepressants.

The exact mechanism of action is not yet clear. However, it is believed that due to its small size, lithium can occupy potassium, sodium, and calcium channels and block them, especially in neuronal enzymes or neurotransmitter receptors. The prevailing hypothesis in science is that lithium acts at glutamate receptors. Lithium is believed to alter influxes and effluxes of glutamate receptors - particularly GluR3 - without shifting the reversal potential. Lithium is thought to keep the amount of glutamate between individual neurons constant, i.e., neither too large nor too small. Indeed, it is believed that too much glutamate is responsible for manias and too little glutamate for depression .

Lithium is excreted unchanged in the urine by the kidneys. Lithium is not bound to plasma proteins. Since blood lithium levels tolerate very minimal fluctuations, regular blood checks should be performed to keep lithium levels constant between 0.5 mmol/L and 1.2 mmol/L. Lithium levels above 3 mmol/L can be life-threatening.The half-life, i.e., the time required for the body to excrete half of the active substance, is approximately 24 hours.

Always take lithium exactly as described in the package leaflet or exactly as your doctor has told you.

The usual recommended dose for adults and children 12 years and older is 1800 mg per day.

The maintenance dose for long-term use is 900 - 1200 mg per day.

A lower dose should be prescribed for people over 65 years of age.

The following side effects may occur:

• tremor
• increased urination
• thirst
• nausea

The above side effects are mostly present at the beginning and usually subside after some time.

Other side effects may include:

Cardiovascular and vascular disorders:

• irregular or slow pulse
• low blood pressure
• cold hands and feet(Raynaud's syndrome)
• circulatory collapse
• ECG changes

nervous system disorders:

• Tremors
• Muscle twitching
• Movement disorders
• involuntary movements of arms and legs
• slowed movements
• cramps
• dizziness
• drowsiness
• eye tremor
• headaches
• slurred speech
• seizures
• inflammatory brain swelling
• Rigidity
• coma
• muscle weakness
• decreased nerve conduction velocity
• peripheral neuropathy

skin diseases:

• partial hair loss
• acne
• hair root inflammations
• itching
• worsening of psoriasis
• swelling of skin and mucous membrane
• Rash
• Hypersensitivity reactions
• Eruptions on the skin or mucous membrane

Endocrine system disorders:

• Dysfunction of thyroid and parathyroid glands.
• Enlargement of the thyroid gland (hyperthyroidism)

Gastrointestinal tract disorders:

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• gastritis
• excessive saliva production
• dry mouth

Blood disorders:

• Increase in white blood cells (leukocytosis).

Metabolic diseases:

• Increase in blood glucose
• increase in serum calcium
• Weight gain

Diseases of skeletal muscles, connective tissues and bones:

• Joint pain
• muscle pain
• Water retention in the tissues (edema)

Psychiatric disorders:

• Hallucinations
• Drowsiness
• Memory loss

Kidney disorders:

• increased urination
• Urinary incontinence
• impaired kidney function
• acute kidney failure
• kidney tumors (in case of long-term treatment)

diseases of the sexual organs:

• sexual dysfunction
• impotence

Diseases of the sensory organs:

• visual field defects
• blurred vision
• taste sensation disorders

Drug interactions may occur with concomitant use of the following drugs:

• Metronidazole
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• medicines for high blood pressure or heart failure
• medicines for drainage
• empagliflozin
• Dapagliflozin
• Urea (urea)
• Xanthines (e.g. caffeine)
• Sodium bicarbonate
• Neuroleptics
• Carbamazepine
• Methyldopa
• Agents for the treatment of depression
• Calcium channel blockers

Lithium must NOT be taken in the following cases:

• in case of allergy to lithium

Lithium should NOT be taken by those under 12 years of age due to lack of experience.

A lower dose should be prescribed for those over 65 years of age.

Pregnancy

Lithium should NOT be taken during pregnancy unless your doctor feels that it is absolutely necessary. Lithium has a mild teratogenic effect, which means that it may cause malformations in unborn children.

In the 1st trimester of pregnancy, research has shown that it can cause heart malformations (Ebstein's anomaly). This is a malformation of the leaflets of the tricuspid valve in the heart. Recent studies have found that the risk of malformation depends on the dosage.

In the 2nd & 3rd trimesters of pregnancy, after taking lithium, the newborn may experience adjustment disorders after birth. Cardiac arrhythmias, as well as respiratory disorders or temperature regulation disorders in the newborn baby may occur. Therefore, a birth in a clinic with neonatology is mandatory. In addition, hypothyroidism and diabetes insipidus (diabetes in the fetus) can occur in the unborn child during pregnancy.

If lithium is nevertheless taken during pregnancy, the unborn baby should be closely monitored by ultrasound.

As an alternative in bipolar affective disorders, atypical antipsychotics, such as quetiapine, could be used.

Lactation

Lithium should NOT be taken during lactation . Lithium passes into breast milk. Plasma concentration measurements showed that the concentration in infants can be up to 58% of that in the mother. This may cause numerous effects and side effects in the infant. In individual cases, lithium therapy may be continued despite breastfeeding in consultation with your physician. However, this requires a very low maternal lithium dose and very close infant monitoring by the pediatrician with possible regular blood checks of the infant.

As early as 1850, lithium was used as a drug, namely against gout. However, this turned out to be ineffective, but research continued until 1949, when the Australian psychiatrist John Cade described a possible field of application. He tested lithium on guinea pigs and noticed a marked change in the animals' behavior.

John Cade then attempted to take his own life, after which lithium was studied as a drug for the treatment of depression, schizophrenia and mania in a hospital in Denmark in 1952-1954.