Starting lithium for bipolar disorder can come with a mix of hope, uncertainty and a lot of questions — and that’s completely understandable. Lightfully Behavioral Health recognizes how challenging it can be to navigate this condition and add new mental health medications into your routine. In this article, we’ll discuss some of the most common questions we get from people with bipolar disorder about lithium treatment so that you can learn more about it.

1. What is lithium and how does it work?

Widely recognized as a preferred treatment option for bipolar disorder, lithium is a mood stabilizer. Researchers are still learning exactly how it works, but it may influence certain neurotransmitters, like serotonin, and other substances in your brain that affect your moods, thoughts and behaviors. Recent research also indicates that it may also have neuroprotective properties that support cognitive health.

It’s currently available by prescription in the following forms:

• Tablets (300 mg)
• Extended-release tablets (300 mg, 450 mg)
• Capsules (150 mg, 300 mg, 600 mg)
• Liquid solutions (8 mEq/5 mL)

2. Who typically benefits most from lithium?

Lithium is FDA approved for acute mania and maintenance treatment in people with bipolar disorder. It’s designed to help lessen how often manic episodes occur and how intense they feel. However, it may also be a helpful off-label treatment for depression.

3. How long does lithium take to start working?

You may notice that your bipolar disorder symptoms start to improve within two weeks of starting lithium. However, it can take several weeks — or even a few months — before it helps your manic episodes become more manageable. During this initial period, it’s important that you reflect on how you’re feeling and communicate with your provider. That way, you can work together to decide if this mediation is right for you and optimize your dosage.

4. What does starting lithium treatment look like?

Lithium is typically taken one to three times each day, and you can take it with or without food — whichever feels easier on your stomach. Many providers recommend starting with a lower dose of the medication and gradually increasing it over several weeks; they can adjust your dose based on how you’re feeling and how your symptoms respond.

5. What are the potential side effects of lithium?

Like other medications, people taking lithium may experience some side effects. Possible side effects for lithium include:

• Frequent urination
• Increased thirst
• Stiff arms or legs
• Difficulty breathing, especially during physical activity
• Unusual fatigue or weakness
• Weight gain
• Tremors
• Gastrointestinal upset

In rare cases, side effects may include:

• Bluish tint in the fingers and toes
• Coldness in the arms and legs
• Dizziness
• Eye pain or vision problems
• Headaches
• Unusual noises in the ears

Keep in mind that other side effects may occur, and they might fade as your body adjusts to the medication. Still, be sure to let your provider know if anything feels unusual. They can help you manage these effects or talk with you about whether a different medication might be a better fit.

6. What is lithium toxicity?

Lithium toxicity is a potentially life-threatening condition that can happen if you take too much lithium, though it can also occur even at prescribed doses from dehydration, illness or drug interactions. The symptoms of lithium toxicity can vary, but may include:

• Stomach pain, nausea, vomiting or diarrhea
• Mental status changes, like confusion or delirium
• Muscle weakness or uncontrolled shaking (tremors)
• Coordination and balance issues
• Slurred speech

If you notice these or other severe symptoms, seek immediate medical assistance.

7. What lab tests will I need and how often?

Your provider may order blood and urine tests to keep tabs on your lithium levels and overall health while you’re on this medication. This may include baseline lab testing before you start taking it, plus additional tests at each visit, and after every dose change, to monitor for lithium toxicity. Once you’ve reached an optimal dosage, they may order tests every three to six months to monitor your kidney and thyroid functions.

8. Can I take other medications with lithium?

Yes, but some prescription and nonprescription medications may interact negatively. It’s important to talk to your provider about any medications or supplements you’re currently taking and before starting anything new. For instance, here are just a few of the medications that may influence the effects of lithium:

• Diuretics
• Nonsteroidal anti-inflammatory medications (NSAIDs)
• Certain blood pressure medications
• Some antidepressants

9. Can I take lithium while pregnant or breastfeeding?

If you’re pregnant or thinking of becoming pregnant, be sure to mention this to your provider. Taking lithium is associated with a rare risk of congenital heart defects, such as Ebstein anomaly. Your provider may recommend a fetal echocardiogram during the first trimester to check on your baby. They’ll also likely monitor your lithium levels more frequently. After childbirth, they’ll examine your baby for potential effects.

Generally, it’s not recommended to breastfeed while taking lithium because it can pass through to your child.

Learn more about bipolar disorder and lithium treatment

It’s natural to wonder how starting a new bipolar disorder treatment might affect your daily life and overall health, but remember that you don’t have to navigate this journey alone. The licensed clinical therapists and psychiatrists at Lightfully are here to provide support, guidance and professional care. 

Lightfully is committed to working closely with you to monitor your progress, address any side effects and adjust your treatment plan as needed. Our approach is centered on evidence-based, whole-person care that’s both compassionate and responsive to your needs. In addition to medication management, our levels of care also include psychotherapy to help make sure you have the tools you need to manage your mental health.

You deserve a brighter version of you. When you’re ready to take the first step, our Admissions Concierge Team is ready to walk alongside you.