A nurse is caring for a client who has bipolar disorder and a new prescription for lithium

beginning of content

  • Lithium is a medication used to treat certain mental illnesses such as bipolar disorder.
  • For some people, lithium can help decrease abnormal activity in the brain, manic episodes and suicidal feelings.
  • Short-term side effects can include shaking, fatigue, headache and gastrointestinal problems, while a long-term side effect can be weight gain.
  • If you take lithium your doctor will monitor your kidney function, thyroid function and how much lithium is in your blood.
  • Lithium is just one treatment option, usually prescribed initially by a psychiatrist. Your doctor will decide if it’s right for you.

What is lithium?

Lithium is a chemical element found in nature that is sometimes used in medicines to treat certain mental illnesses, such as bipolar disorder. Lithium can treat acute mania, or 'highs', and help with longer-term mood stabilisation.

It's also used in treating some types of depression and other types of mental illness.

If you have a mental illness, your doctor will decide if medication is the right treatment for you. Lithium is just one option.

How does lithium work?

Lithium works by changing the release of chemicals in the brain.

It can take some time to get the dosage right and it may be weeks or even months before it affects your mood. If you take lithium, you will need regular appointments with your doctor to make sure you are not taking too little or too much lithium.

What are the benefits of lithium?

Lithium helps reduce the severity and frequency of mania — the elevated, euphoric end of the mood scale — and may help to treat bipolar depression.

If you have been at risk of suicide, lithium may help reduce these feelings. Lithium also helps prevent manic and depressive episodes occurring in the future. Therefore, your doctor may prescribe it over long periods of time to prevent relapse.

Important things to remember when taking lithium

  • Tell your doctor or pharmacist if you have any allergies.
  • If you are taking diuretics (water pills), tell your doctor since these may need to be carefully monitored.
  • Tell your doctor about any other medicines, supplements or complementary medicines you are taking, as they may interact with lithium.
  • If you are pregnant, planning to become pregnant or breastfeeding, tell your doctor straight away. Lithium may cause harm to a fetus or baby.
  • Tell your doctor first if you have any heart or kidney problems.
  • Lithium can cause drowsiness, so it is important to consider this if driving or operating heavy machinery

Short-term side effects

You may have some short-term side effects when starting treatment with lithium or changing dose. It's important to weigh up these short-term side effects with the benefit lithium may have for the symptoms of the mental illness.

Short-term sides effects can include:

These side effects usually go away after a few days. If side effects continue or are worrying you, see your doctor. If they suddenly get worse, it may be a sign of 'lithium toxicity', or too much lithium in your body (see below). If this happens, call your doctor immediately.

Long-term side effects

Taking lithium for long periods can affect your kidneys and your thyroid. Lithium can also cause drowsiness.

Your doctor will carry out blood tests regularly to monitor how much lithium is in your blood. They will also monitor your kidney function, your thyroid gland and your parathyroid gland.

Some people who take lithium for long periods gain weight. A healthy diet and regular exercise can help you keep your weight under control. Talk to your doctor about managing your weight.

Women who take lithium are usually advised to use other medicines while pregnant.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

What is lithium toxicity?

You can develop lithium toxicity suddenly if you take too many tablets at once or combine lithium with certain other medicines.

If you are on a steady dose of lithium, you may get chronic lithium toxicity when your kidneys stop working properly.

Lithium toxicity can cause:

If you think you or someone you care for may have lithium toxicity, it's important to talk to a doctor immediately.

See healthdirect's medicines section for more information about lithium.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2020

These trusted information partners have more on this topic.

Healthdirect Australia is not responsible for the content and advertising on the external website you are now entering.

Worried about your health?

Select a symptom, answer some questions, get advice.

Start Your Symptom Check

Check your symptoms Find a health service

1. Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68:241–251. [PMC free article] [PubMed] [Google Scholar]

2. Sidor MM, Macqueen GM. Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry. 2011;72:156–167. [PubMed] [Google Scholar]

3. Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. The World Journal of Biological Psychiatry. 2013;14(3):154–219. [PubMed] [Google Scholar]

4. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders; 2013;15(1):1–44. [PubMed] [Google Scholar]

5. National Institute for Health and Care Excellence. Bipolar disorder: The assessment and management of bipolar disorders in adults, children and young people in primary and secondary care. Draft for consultation, April 2014. http: //www.nice.org.uk/

6. American Psychiatric Association. Guideline Watch: Practice guideline for the treatment of patients with bipolar disorder. 2nd ed. Washington DC: American Psychiatric Association; 2005. [Google Scholar]

7. Goodwin GM. Evidence –based guidelines for treating bipolar disorder: revised second edition- recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2009;23:346–388. [PubMed] [Google Scholar]

8. Cipriani Andrea, et al. “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis.” The Lancet 378.9799. 2011:1306–1315. [PubMed] [Google Scholar]

9. Fountoulakis KN, Kontis D, Gonda X, Yatham LN. A systematic review of the evidence on the treatment of rapid cycling bipolar disorder. Bipolar disorders. 2013;15(2):115–137. [PubMed] [Google Scholar]

10. Rao PG. An overview of Indian research in bipolar mood disorder. Indian Journal of Psychiatry. 2010;52(Suppl1):S173–S177. [PMC free article] [PubMed] [Google Scholar]

11. Avasthi A, Grover S, Aggarwal M. Research on mood stabilizers in India. Indian J Psychiatry. 2010;52(Suppl S3):355–61. [PMC free article] [PubMed] [Google Scholar]

12. Grover S, Avasthi A, Sinha V, Lakdawala B, Bathla M, Sethi S, Mathur D M, Kathuria P, Shah S, Baalasubramanian D S, Agarwal V, Deka K. Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India. Indian J Psychiatry. 2014;56:253–64. [PMC free article] [PubMed] [Google Scholar]

13. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015;57(Suppl S2):308–23. [PMC free article] [PubMed] [Google Scholar]

14. Tighe SK, Mahon PB, Potash JB. Predictors of Lithium Response in Bipolar Disorder. Therapeutic Advances in Chronic Disease. 2011;2(3):209–226. [PMC free article] [PubMed] [Google Scholar]

15. Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013;346:f3646. [PubMed] [Google Scholar]

16. Malhi GS, Tanious M. Optimal frequency of lithium administration in the treatment of bipolar disorder: clinical and dosing considerations. CNS Drugs. 2011;25(4):289–98. [PubMed] [Google Scholar]

17. Ng F, Hallam K, Lucas N, Berk M. The role of lamotrigine in the management of bipolar disorder. Neuropsychiatric disease and treatment. 2007;3(4):463. [PMC free article] [PubMed] [Google Scholar]

18. Bowden C. L, Asnis G. M, Ginsberg L. D, Bentley B, Leadbetter R, White R. Safety and tolerability of lamotrigine for bipolar disorder. Drug safety. 2004;27(3):173–184. [PubMed] [Google Scholar]

19. Tränkner A, Sander C, Schönknecht P. (2013). A critical review of the recent literature and selected therapy guidelines since 2006 on the use of lamotrigine in bipolar disorder. Neuropsychiatric disease and treatment. 2013;9:101. [PMC free article] [PubMed] [Google Scholar]

20. Tohen M, Zhang F, Taylor CC, Burns P, Zarate C, Sanger T, Tollefson G. A meta-analysis of the use of typical antipsychotic agents in bipolar disorder. Journal of affective disorders. 2001;65(1):85–93. [PubMed] [Google Scholar]

21. Gao K, Gajwani P, Elhaj O, Calabrese JR. Typical and atypical antipsychotics in bipolar depression. The Journal of clinical psychiatry. 2005;66(11):1376–1385. [PubMed] [Google Scholar]

22. Gigante AD, Lafer B, Yatham LN. Long-acting injectable antipsychotics for the maintenance treatment of bipolar disorder. CNS drugs. 2012;26(5):403–420. [PubMed] [Google Scholar]

23. De Berardis D, Marini S, Carano A, Padovan Lang A, Cavuto M, Piersanti M, Di Giannantonio M. Efficacy and safety of long acting injectable atypical antipsychotics: a review. Current clinical pharmacology. 2013;8(3):256–264. [PubMed] [Google Scholar]

24. Chou YH, Chu PC, Wu SW, Lee JC, Lee YH, Sun IW, Yen YC. A Systemic Review and Experts’ Consensus for Long-acting Injectable Antipsychotics in Bipolar Disorder. Clinical Psychopharmacology and Neuroscience. 2015;13(2):121. [PMC free article] [PubMed] [Google Scholar]

25. Joffe RT, MacQueen GM, Marriott M, Robb J, Begin H, Young LT. Induction of mania and cycle acceleration in bipolar disorder: effect of different classes of antidepressant. ActaPsychiatricaScandinavica. 2002;105(6):427–430. [PubMed] [Google Scholar]

26. Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biological psychiatry. 2000;48(6):558–572. [PubMed] [Google Scholar]

27. Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. American Journal of Psychiatry. 2014;161:1537–47. [PubMed] [Google Scholar]

28. Henry C, Sorbara F, Lacoste J, Gindre C, Leboyer M. Antidepressant-induced mania in bipolar patients: identification of risk factors. Journal of Clinical Psychiatry. 2001;62(4):249–255. [PubMed] [Google Scholar]

29. TohenM Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, Breier A. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Archives of general psychiatry. 2003;60(11):1079–1088. [PubMed] [Google Scholar]

30. McElroy SL. Prescribing antidepressants for bipolar depression: what does the evidence say? The Journal of clinical psychiatry. 2014;75(9):e24–e24. [Google Scholar]

31. Silverstone T. Moclobemide vs. imipramine in bipolar depression: a multicentre double-blindclinical trial. ActapsychiatricaScandinavica. 2001;104(2):104–109. [PubMed] [Google Scholar]

32. Nivoli AM, Colom F, Murru A, Pacchiarotti I, Castro-Loli P, González-Pinto A, Vieta E. New treatment guidelines for acute bipolar depression: a systematic review. Journal of affective disorders. 2011;129(1):14–26. [PubMed] [Google Scholar]

33. Vázquez GH, Tondo L, Undurraga J, Baldessarini RJ. Overview of antidepressant treatment of bipolar depression. International Journal of Neuropsychopharmacology. 2013;16(7):1673–1685. [PubMed] [Google Scholar]

34. Schöttle D, Huber CG, Bock T, Meyer TD. Psychotherapy for bipolar disorder: a review of the most recent studies. Current opinion in psychiatry. 2011;24(6):549–555. [PubMed] [Google Scholar]

35. Scott JAN, Paykel E, Morriss R, Bentall R, Kinderman P, Johnson T, Hayhurst H. Cognitive–behavioural therapy for severe and recurrent bipolar disorders. The British Journal of Psychiatry. 2006;188(4):313–320. [PubMed] [Google Scholar]

36. Miklowitz DJ. A review of evidence-based psychosocial interventions for bipolar disorder. Journal of Clinical Psychiatry. 2006;67:28. [PubMed] [Google Scholar]

37. Chanpattana W. Combined ECT and clozapine in treatment-resistant mania. J ECT. 2000;16:204–207. [PubMed] [Google Scholar]

38. Devanand DP, Polanco P, Cruz R, Shah S, Paykina N, Singh K, Majors L. The efficacy of ECT in mixed affective states. J ECT. 2000;16:32–37. [PubMed] [Google Scholar]

39. Mukherjee S, Sackeim HA, Schnur DB. Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience. Am J Psychiatry. 1994;151:169–176. [PubMed] [Google Scholar]

40. Ismail Shihabuddeen TM, Gopinath PS. Group meetings of caretakers of patients with schizophrenia and bipolar mood disorders. Indian J Psychiatry. 2005;47:153–6. [PMC free article] [PubMed] [Google Scholar]

41. Durgam S, Starace A, Li D, Migliore R, Ruth A, Németh G, Laszlovszky I. The efficacy and tolerability of cariprazine in acute mania associated with bipolar I disorder: a phase II trial. Bipolar Disord. 2015;17:63–75. [PubMed] [Google Scholar]

42. Muneer A. The Treatment of Adult Bipolar Disorder with Aripiprazole: A Systematic Review. Cureus. 2016 Apr;8(4):e562. [PMC free article] [PubMed] [Google Scholar]


Page 2

Components of assessment and evaluation

A nurse is caring for a client who has bipolar disorder and a new prescription for lithium