The problem with Lithium

Lithium has been considered the gold standard of treatment for bipolar disorder since it was first introduced into the world of psychiatry in the late 1950s.   At the time, it was a major breakthrough in the treatment of bipolar disorder, and also found a substantial use in the control of impulse disorders.   The problem from the outset has been a numerous host of side effects -- including weight gain, acne, and possible permanent damage to the thyroid gland and kidneys.  The latter two require frequent and rigorous management with evaluation by blood testing.  However, in the past few years something more difficult has been known to occur with long term Lithium usage -- a problem with effects the central nervous system called "SILENT" - the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity.   SILENT defines a syndrome in which Lithium causes a process called "demyelination" -- which means that the delicate membranes which surround nerve cells in the brain are damaged -- and this can result in many different neurological problems which are usually irreversible.  The problem with SILENT is that it can occur even when Lithium levels are within normal limits, and when all other blood chemistries are normal.   Because of this, if you suffer from bipolar disorder and are taking Lithium, it's definitely worth having a long talk with your provider about this risk, and possibly switching to another mood stabilizer.   At this point, there are many alternative choices, including Depakote, Tegretol, Lamictal and Topomax, as well as many second generation neuroleptics - such as Abilify, which can be helpful in managing both Bipolar I and Bipolar Type II.   They have risk profiles of their own but are often easier to use and if they do cause side effects those can be treated are usually reversible.  It's always wise to discuss this in detail with your health care providers.  Medicines should help and not hurt.  Make sure you're on the right track and know your options. 

David Salvage, MD, FAPM

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