hi I'm dr. Tracy marks a psychiatrist
and I make mental health education
videos today I'm talking about when we
do and don't use lithium for bipolar
disorder and this was based on a viewer
question from Libby and she asks dr.
marks will you please talk about when is
the best time to take lithium for
bipolar I've had it for years and my
doctor never prescribed it I heard it's
the best treatment but I've also heard
it causes a lot of long-term problems
can you also say what you think about
lithium orotate thank you thanks Libby
for this question yes lithium is the
first recommended treatment for bipolar
disorder but it's only when you have
classic bipolar disorder classic bipolar
disorder is when you have a clean
separation between depressive episodes
and manic episodes I've defined
depression and mania in several videos
and I'll link my bipolar playlist in the
corner a clean separation means that
when one episode is over you return to
your baseline until the next episode
comes and you don't have lingering
depression with anxiety mixed in I've
mentioned before that the real classic
picture of bipolar disorder is that you
have alternating episodes of mania and
depression but for lithium to be helpful
the episodes don't have to alternate and
that's probably not the majority of
people anyway there are people who have
multiple manic episodes in a row while
others may have mostly depression with
an occasional manic episode but either
way in between you're pretty free of
symptoms other than the situational ups
and downs of life lithium is not a good
choice though when you have a mixture of
mania and depression symptoms happening
at the same time and we call this
bipolar disorder with mixed features so
you have the hyper arousal of mania
where you're sped up you may be
impulsive using poor judgment irritable
or angry while also having at least
three depressive symptoms along with
your mania and I describe this in more
detail in my mix
mania video in the case of mixed
features the recommended first choice is
an anti-psychotic medication like
quetiapine we use the second-generation
antipsychotic medications as mood
stabilizers in bipolar disorder one
thing that lithium does that the other
medications don't do as well is it
reduces suicidal thinking the only other
medication that addresses this at a
similar level is ketamine which we use
for treatment-resistant unipolar
depression and by the way the depression
and bipolar disorder is considered to be
a different entity from the depression
that you get with unipolar depression so
not everything that works for unipolar
or major depression works for bipolar
depression so here's some side effects
of lithium lithium can cause weight gain
tiredness fuzzy thinking similar to some
of the other mood stabilizers but
lithium also has some side effects that
can come along with long-term use
lithium can cause your thyroid to
malfunction such that you start to
produce in adequate amounts of thyroid
hormone so some people who take lithium
long term eventually knee thigh roid
supplementation I've had some patients
stop taking lithium because of this
problem and nothing seemed to work as
well though as the lithium some of these
patients chose to stay on lithium and
just take thyroid supplementation the
second long-term side effect is to your
kidneys everyone has some decline in
kidney function as you get older but
long-term lithium use can accelerate
this process you can also get a
condition called diabetes insipidus and
this is different from diabetes mellitus
where you get elevated blood sugars with
insipidus your kidneys lose its ability
to concentrate your urine so you get
frequent urination and excessive thirst
diabetes insipidus can happen even
within the first weeks two months of
taking lithium it usually resolves on
its own but it can persist in about 25%
of people sometimes this problem can be
hoped by taking your lithium all at once
at bedtime if the problem still
doesn't go away though but it's probably
best to switch to a different mood
stabiliser if you catch it early it's
reversible usually within weeks another
way lithium can damage your kidneys is
if it gets too concentrated in your
blood it can reach toxic levels and
damage your kidneys and so that's why
it's important to have your lithium
levels checked on a regular basis and
you have to make sure you stay hydrated
if you lose a lot of fluid from
excessive sweating diarrhea or vomiting
watch carefully for signs of lithium
toxicity early signs of lithium toxicity
or tremor slurred speech feeling tired
and weak you can also get diarrhea and
vomiting from the toxicity if you start
feeling this way you should get yourself
to an emergency room or urgent care to
be evaluated if you're on lithium make
sure all of your doctors know so that
they can check any drug interactions
from the medications that they prescribe
also if you have pain problems watch
your consumption of non-steroidal
anti-inflammatory medications like Advil
or Aleve this class of medication can
increase lithium levels the last part of
Libby's question is about lithium
orotate and this is a version of lithium
that's available over-the-counter it's a
much lower dose than lithium that you
get with a prescription and the
prescription versions are lithium
carbonate and lithium citrate well given
all of what I just said about the risks
of lithium I don't know how people can
feel comfortable taking it unmonitored I
realize it's a low dose but because you
can buy it on your own you can take as
much as you want so what if one pill
doesn't work well enough how much more
do you take what will your level turn
out to be if you do take more what
happens if you go to a picnic in the
heat of the summer you drink beer you
urinate a lot you sweat a lot what does
your lithium level look like how many
people even know to check for that so my
opinion about lithium orotate is I think
it's a bad idea to take on your own
given the side effect risks but asked
for the prescription lithium yes it
comes with significant side effects but
it's still a tried-and-true
treatment for a classic bipolar disorder
but like anything it's not guaranteed to
work and if you have mixed symptoms or
you just don't want to take it there are
plenty of other options that you and
your doctor can try thanks again for the
question Libby see you next