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TREATMENTS FOR PROBLEMS WITH MOODDrugs known as Mood Stabilisers(sometimes known as anti-manics and mood normalisers)DRUG:- LITHIUM
Lithium is one of a number of drugs
that can help to stabilise, normalise or even-out mood
swings. It can help if you get either low or high e.g.
depression that either won't go away or keeps coming back.
It can help to prevent mood swings in the future in
people who suffer from bipolar mood disorder (known as
manic-depression or bipolar affective disorder). It is
better at preventing the return of highs than of lows.
Lithium is also occasionally used to help treat many
other conditions e.g. aggression. It also has other uses
e.g. for cluster headaches.
It is not known exactly
how lithium works. There are many theories, but it
probably evens-out or stabilises the speed at which the
brain passes messages around, and stabilises cells and
nerves and 'secondary messengers'. Lithium itself is
similar to the sodium in salt.
Tablets Tablets should be swallowed with at least half a glass of water whilst you are sitting or standing so that they reach the stomach and do not stick in the throat. 'Litarex', 'Liskonum', 'Camcolit 400', and 'Priadel' tablets should be swallowed whole and not chewed. These tablets are made so that they release lithium over a longer period of time. This can help to reduce side-effects or reduce the number of times a day you need to take this medicine. If you cannot swallow them whole they can be broken. Do not crush, chew or dissolve them as this will cause the drug to be released too quickly and you may get more side effects. Liquids Your pharmacist should
give you a medicine spoon or oral syringe. Use it
carefully to make sure that you measure the correct
amount. Ask your pharmacist for a medicine spoon if you
do not have one.
Take the doses as directed
on the medicine label. You should take it at regular
times or at a regular time each day. Taking a dose at
mealtimes may make it easier to remember as there is no
problem about taking lithium with or after food. If the
instructions say to take lithium ONCE a day this is
usually best at bedtime.
It may take several weeks
before you begin to feel better. For people who suffer
from manic depression it may take many months before the
depressive part of this illness improves.
You should discuss this with your doctor as people respond differently. People usually need to take lithium for quite some time after it has been started. As well as treating the illness, lithium also helps to prevent the symptoms returning. Once you have started lithium, you may need to take lithium for a long time, probably for at least two or three years and quite possibly much longer. For it to continue keeping you well, lithium must be taken each and every day. Stopping and starting it will probably be harmful to you.
Lithium is not addictive
as such but a some people do get some short-term effects
if lithium is stopped suddenly (but see below). For
further discussion, click here.
Absolutely not! It is very
unwise and risky to stop taking lithium suddenly, even if
you feel better. Recent studies have shown that if you
are taking lithium for bipolar disorder and stop it
suddenly (ie over 1 to 14 days) you have a 1 in 2 (50%)
chance of becoming ill again within six months and a 90%
chance of becoming ill again within 3 years. If you need
to stop lithium, it should be gradually over at least
four weeks, preferably longer i.e. 3-6 months The dose
should be decreased gradually during this time to
minimise possible problems. You've got a lot to lose if
you stop lithium too quickly. (See also "How long
will I need to keep taking lithium for?" above).
Start again as soon as you
remember unless it is almost time for your next dose,
then go on as before. Do not try to catch up by taking
two or more doses at once as you may get more side-effects.
You should tell your doctor about this next time you meet.
If you miss several doses start again when you remember
and tell your doctor. You may need a new blood test to
check that there is enough, but not too much, lithium in
your blood. If you miss an occasional dose (e.g. a day or
two every few weeks) it is unlikely that you will become
ill again. If you have problems
remembering your doses (as very many people do) ask you
pharmacist, doctor or nurse about this. There are some
special packs, boxes and devices which can be used to
help you remember.
Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk ) Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet. The following side-effects may show that the level of lithium in your blood is too high:-
If you get any of these side-effects do not take any more tablets and contact your doctor as soon as possible. You should avoid exercise in hot weather or other things that cause heavy sweating (e.g. having a sauna). If your dose and blood is monitored well, lithium does not really have any major long term side-effects.
Lithium may make you feel drowsy at first. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as this may affect your reflexes or reaction times.
It is not uncommon for people to put on some weight when taking lithium. This may in part be because a common side-effect of lithium therapy is feeling thirsty, and drinking large amounts of high calorie drinks can cause people to put on weight. If this happens, try drinks which are low in calories e.g. low calorie squash or water, and cut down on sugar and milk in your tea and coffee. It is impossible to know what the effect on your weight may be because each person will be affected differently. It is important that you do not ignore feelings of thirst as this can lead to lithium poisoning. This is very important especially if you go on holiday to a hot country where you may be sweating heavily too (see side-effects above). If you do start to put on weight or have problems with your weight, your doctor can arrange for you to see a dietitian for advice. Any weight you put on can be controlled while you are still taking this medication, with expert advice about diet. In some people weight gain can be a serious problem. If it causes you distress make sure your doctor knows about this. A change in your dose may be necessary in extreme cases.
Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Lithium has not been reported to have a major adverse effect on these three stages. However, if this does seem to happen, you should discuss this with your doctor, as a change in dose may help minimise any problem.
There is not a complete
ban on drinking alcohol if you are taking lithium, try
not take more than about one or two drinks a day as this
may affect the level of lithium in your blood. It may
also cause you to feel more drowsy. This is especially
important if you need to drive or operate machinery as it
can affect your reaction times. You should seek advice on
this.
It is important that you do not drink too much or too little fluid (e.g. do not ignore feelings of thirst) as this can lead to lithium poisoning. Drinking lots of high calorie drinks can, however, cause you to put on weight (see weight gain above).
There are a number of drugs which can affect the lithium levels in your blood. You should tell your doctor before stopping or starting any other medication. You should also show your lithium card to any doctor, dentist or pharmacist who may treat you. If you get a headache or
pain, you should take paracetamol rather than aspirin or
ibuprofen ('Nurofen' etc.) if you need to. Aspirin,
ibuprofen and other NSAIDs (Non-Steroidal Anti-Inflammatory
Drugs) can cause the lithium level in your blood to rise
which can lead to lithium poisoning. Some of the other
drugs which can 'interact' with lithium include
treatments for high blood pressure (e.g. diuretics),
arthritis, asthma and infections. This does not
necessarily mean the drugs can not be used together, just
that you may need to follow your doctor's instructions
very carefully.
It is not thought that the
contraceptive pill is affected by lithium.
It is important to
consider that there will be a risk to you and your child
from taking a medicine during pregnancy but also a
possible risk from stopping the medicine e.g. getting ill
again. Unfortunately, no decision is risk-free. It will
be for you to decide which is the least risk. All we can
do here is to help you understand some of the issues, so
you can make an informed decision. For your information,
major malformations occur spontaneously in about 2-4% of
all pregnancies, even if no drugs are taken. The main
problem with medicines is termed "teratogenicity"
i.e. a medicine causing a malformation in the unborn
child. A medicine causing teratogenicity is called a
"teratogen". Since a baby has completed its
main development between days 17 and 60 of the pregnancy
(the so-called "first trimester") these first 2-16
weeks are the main concern. After that, there may be
other problems e.g. some medicines may cause slower
growth. The infant may also be affected after birth e.g.
withdrawal effects are possible with some drugs. B = Animal and human studies indicate a lack of risk but are not fully conclusive C = Animal studies indicate a risk but there is no safety data in humans D = a definite risk exists but the benefit of the drug may outweigh the risk in some people X = the risk outweighs any possible benefit Lithium is classified as "D". There is much controversy about lithium in pregnancy. Early data from Scandinavia indicated a problem, but recent studies have indicated that the risk of problems is only slightly higher than in women not taking lithium. The other things to consider are that:
The major risk with lithium in pregnancy is something called Ebstein's anomaly, a rare heart defect in the child. The chance of this happening without lithium is about 1 in 20,000 children, and this rises to about 1 in 1000 with lithium (i.e. 20 times higher, but still rare). This heart problem can be detected so you should seek personal advice from your GP, who will arrange for specialist screening to be carried out. Regular blood monitoring will be important as you get closer to your due date as lithium levels may rise towards the end of pregnancy. You should, however, still seek, who may then if necessary seek further specialist advice. One piece of good news is that one study was able to show that lithium did not appear to have an effect on physical or mental development over the first 5-10 years of the child's life if the mum took lithium throughout pregnancy.
The aim of treatment with lithium is for the amount of lithium in your blood to reach the level needed to help your symptoms, but not to get high enough to give you side effects. Everybody is different and so your lithium dose needs to be exact for you. It will depend on your age, weight, height, etc. To do this, a blood sample needs to be taken and checked. This will need to be done about every week at the start of treatment but later on only about every three months. When you are stable, make sure that you have a blood test at least every three months. You may need to have extra tests if you get any increase in side effects (see previous pages for a list of these), if you get diarrhoea (the 'runs'), if you have to take any drugs which might interact with the lithium or if the weather is very hot. All these things can upset your lithium level and give you side effects. The level of lithium in your blood needed to give you the right balance between positive effects and side effects will be a personal thing. In general, the accepted wisdom is that:
Please note that these are general comments for advice only, and your individual case may be different. Please discuss this with your doctor or other carer if you have any questions about this. If you normally have a
dose in the morning and a blood test within about four
hours, you should delay this morning dose until after
your blood test or it will upset the result.
You may feel drowsy and/or confused at first when taking lithium. Until this wears off, or you know how your drug affects you, do not drive or operate any type of machinery. You should be careful as this may affect your reaction times or reflexes. It is against the law to drive, attempt to drive or be in charge of a vehicle when unfit, either through illness or from the side effects of medication. Under UK law, it is the driver's responsibility to let the DVLA and insurance company know if you may be 'unfit' to drive. If you do not, and you have an accident, it could affect your insurance cover. Your doctor will be able to advise you, and may wish to access the UK Driver and Vehicle Licensing Agency (DVLA) guidelines website, which has the current DVLA guidelines on anxiety/depression, psychotic disorders, mania and other conditions. If your doctor advises you not to drive, but you continue to do so, the doctor can inform the DVLA directly. Your doctor is lawfully responsible were you to have an accident. Once told, the DVLA may wish to carry out an enquiry, but you are entitled to drive until there a decision is made.
Your pharmacist or doctor should give you a lithium card when you collect your first course of lithium unless you are on a very low dose. You should carry this with you all the time. Show the card to your doctor and pharmacist each time you get a new supply. You should also show it to any doctor, dentist or pharmacist who may treat you. If you lose the card, ask for a new one. Your pharmacist should be able to give you one. |
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Email your comments or feedback. No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support. Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site. |
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Email
your comments or feedback. No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support. Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site. |
What is lithium used for ? 