Medication Guide
Lithium (Lithobid, Eskalith) Side Effects and Uses
A plain-language guide to Lithium, a mood stabilizer. Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Lithium (Lithobid) is a mood stabilizer. Common lithium side effects include fine hand tremor, more thirst and urination, nausea or diarrhea and weight gain. The rare but serious ones, and when to get help, are listed under lithium side effects below. Never stop or change your dose on your own.
How Lithium Can Help You
Lithium is the oldest and best-proven mood stabilizer. It treats mania. Most of all, it helps prevent future high and low episodes in bipolar disorder. It also has strong proof for lowering suicide risk in mood disorders. It can be added to an antidepressant when depression is hard to treat.
In mania, gains often begin within one to three weeks. Its full power to prevent episodes builds over months of steady levels. Stability on lithium often feels like solid ground. Moods still move with life. But they no longer swing to harmful extremes.
Keeping lithium in the right range through regular blood tests is what makes it both safe and helpful.
Uses for Lithium
- Bipolar I mania
- Bipolar maintenance, to prevent high and low episodes
- Lowering suicide risk in mood disorders
- Add-on for hard-to-treat depression (off-label)
- Bipolar II disorder (off-label)
- Schizoaffective disorder, with an antipsychotic (off-label)
How to Take Lithium
Lithium comes as capsules, tablets, slow-release tablets and a liquid. Your prescriber decides the dose. It is based on your blood levels and how you respond. Taking it with food can ease an upset stomach. Take it at the same times each day. Blood tests are timed to your last dose, often about 12 hours after it.
Regular checks are a must. Your lithium level is checked often at first. Once you are stable, it is checked every few months. You will also have kidney and thyroid tests. Long-term lithium can affect both.
Drink enough fluids and keep your salt intake steady. Heat, heavy sweating, vomiting or diarrhea can raise lithium to unsafe levels. If you miss a dose, skip it if the next one is near. Never double up. Never stop lithium all at once, because relapse risk rises sharply.
Lithium Side Effects
Common Side Effects
- Fine hand tremor
- More thirst and urination
- Nausea or diarrhea, mostly early on
- Weight gain
- Sleepiness or dull thinking
- Acne or worse skin problems
- Metal taste in the mouth
- Mild swelling of hands or ankles
Serious: Get Medical Help Promptly
- Lithium toxicity: coarse tremor, vomiting, confusion, stumbling, slurred speech (boxed warning)
- Loss of kidney function with long-term use
- Underactive thyroid (hypothyroidism)
- Serious heart rhythm changes in some people
- Diabetes insipidus (passing lots of watery urine)
- Higher toxicity risk from fluid loss or drugs such as NSAIDs, water pills and ACE inhibitors
How Lithium Works
Lithium is a simple salt. But its effects in the brain are complex. It acts on signals inside nerve cells that help keep mood steady over time. Experts do not fully know how it prevents episodes. Some research suggests it may also help protect brain cells.
Lithium works in a narrow range. Too little does not help. Too much can be toxic. The kidneys clear lithium from the body. So anything that changes kidney function or body fluids can change your level. That is why fluids, salt and other drugs matter so much.
Lithium Toxicity and Drug Interactions
Lithium has a boxed warning. It says toxicity can happen at levels close to the helpful range. Early signs include a worse or coarse tremor and repeated nausea or vomiting. Diarrhea, confusion and odd sleepiness are signs too. So are slurred speech or stumbling. If these appear, get medical care right away.
Some common drugs raise lithium levels. These include ibuprofen, naproxen and other NSAIDs. Water pills, called diuretics, can do it too. So can some blood pressure drugs, such as ACE inhibitors and ARBs. Acetaminophen is often the safer pain choice. Tell every doctor and pharmacist that you take lithium before you start anything new.
Before You Start Lithium
Your prescriber will usually check kidney function and thyroid before you start. Sometimes they check an EKG too. Tell your prescriber about kidney disease, heart disease, thyroid problems and any low-salt diet. If you are pregnant or planning a pregnancy, talk it through. Lithium needs special care in pregnancy.
Lithium lowers suicide risk. But warning signs still need care. If you are thinking about harming yourself, call or text 988, or call 911. You can read more about bipolar disorder care by telehealth from anywhere in California.
Is Lithium Right for You?
Only a full evaluation with a prescriber can tell you if Lithium fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
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Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Carbamazepine (Tegretol), mood stabilizer / anticonvulsant
- Divalproex sodium (Depakote), mood stabilizer / anticonvulsant
- Lamotrigine (Lamictal), mood stabilizer / anticonvulsant
- Oxcarbazepine (Trileptal), anticonvulsant / mood stabilizer (off-label)
FAQ
Questions About Lithium
Why does lithium require blood tests?
Lithium works in a fairly narrow range. Too little does not help, and too much is toxic, so blood levels are the only reliable way to dose it. Levels are checked often at first and then every few months, along with kidney and thyroid tests.
What are the signs of lithium toxicity?
Warning signs include a worse or coarse tremor, repeated nausea or vomiting, diarrhea, confusion, unusual sleepiness, slurred speech and stumbling. Dehydration, illness or new medicines like ibuprofen can trigger it. If these appear, get medical care right away.
Can I take ibuprofen or naproxen with lithium?
NSAIDs like ibuprofen and naproxen can raise lithium levels. They are best avoided or used only with your prescriber's okay. Acetaminophen is often the safer choice for everyday pain.
Will lithium dull my personality or creativity?
Most people find that lithium removes harmful extremes while leaving their core self intact. Untreated episodes often do more harm to creativity and relationships than treatment. If you feel flat or foggy, tell your prescriber, since a change in the plan may help.
How long do I stay on lithium?
Bipolar disorder is a long-term condition, and lithium's biggest strength is prevention. Many people take it for years with good monitoring. Stopping, especially quickly, carries a high risk of relapse, so any taper should be slow and planned with your prescriber.
Why do I feel so thirsty on lithium?
Lithium affects how the kidneys handle water, so more thirst and urination are common. Drink water through the day and keep your salt intake steady. Tell your prescriber if you pass very large amounts of urine.
What should I do if I get sick with vomiting or diarrhea?
Losing fluids can raise your lithium level fast. Call your prescriber for advice, and seek care right away if you notice signs of toxicity. Do not wait it out if you cannot keep fluids down.
Can I drink alcohol while taking lithium?
It is best to avoid alcohol or keep it to a strict limit. Alcohol can dehydrate you and can make mood symptoms worse. Talk with your prescriber about what is safe for you.