• Introduction & Key Points
• Indications for Lithium
• Dosage and administration
• Averse effects of lithium
• Pharmacokinetics and serum concerntrations
• Baseline tests and monitoring
• Drug interactions
• Continuation and maintenance treatment
• Cautions and contraindications to lithium treatment
• Cases
• References
• Issue 3 Contents

Indications for lithium

Lithium is a mood stabiliser. In bipolar disorder it is indicated for acute hypomanic/manic episodes, acute bipolar depression and prophylaxis. Other effective mood stabilisers include sodium valproate, carbamazepine, atypical antipsychotics, and lamotrigine (in bipolar depression). The principles for the use of lithium in bipolar disorder are described in a recent RANZCP guideline.¹

Acute manic episodes

Lithium is used as a mood stabiliser with or without adjunctive/symptomatic treatments such as an antipsychotic or benzodiazepine to manage sleep, agitation, psychosis or aggressive behaviour.

Acute bipolar depression

Lithium is recommended as first-line treatment unless in the past it has been unsuccessful. It may be used as a mood stabiliser with or without an antidepressant. Concomitant antidepressant use is recommended when a faster onset of antidepressant action is required as the antidepressant effects of mood stabiliser monotherapy may take four to six weeks to develop.

Prophylaxis of bipolar disorder

Lithium is used at a lower dose for prophylaxis of bipolar disorder when acute episodes have resolved.

Other

Lithium is also used for augmentation of antidepressant treatment in patients with treatment resistant depression. Whilst it is not registered for this use in New Zealand there is evidence of its benefit when there has been unsatisfactory response to antidepressant treatment. Local guidelines for the treatment of depression recommend lithium augmentation as a possible strategy in this treatment resistant patient group.²