Why must psychiatrists be careful when prescribing the drug lithium?

The most common obstacle as perceived by psychiatrists in prescribing lithium was patient's clinical comorbidities followed by low adherence rate to serum level monitoring. Other frequent reasons preventing starting of lithium were burden of adverse effect monitoring and slow action of lithium [Table 2d].

Why do doctors not prescribe lithium?

In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment.

Why must doctors closely monitor clients taking lithium?

It is a drug with a narrow therapeutic index; therefore, careful therapeutic drug monitoring is needed to maximize effectiveness and to minimize ADEs and toxicity.

Why must lithium levels be carefully monitored and individuals who take this medication?

Treatment is not effective if lithium levels are below the therapeutic range. But if lithium levels are too high, you may experience lithium toxicity, which can cause serious health complications. As a result, lithium treatment requires careful therapeutic drug monitoring.

What are the dangers of lithium?

A short history of lithium, and its remarkable impact on mood disorders | Explainer | ABC News

What is the most concerning side effect of lithium?

Rare/serious side effects

Signs of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, vision changes, and unsteadiness while standing or walking. These symptoms need to be addressed immediately with a medical doctor to ensure your lithium level is not dangerously high.

What organs can lithium damage?

The three organ systems that may be negatively affected by lithium are the thyroid gland, kidneys and parathyroid glands.

Why is lithium a high risk drug?

Lithium is generally safe to take for a long time. Most people take it for years with no problems. If you've been taking lithium for some time, it can cause weight gain. It can also cause problems with your kidneys or thyroid gland.

What should you monitor when a patient is on lithium?

What should I check before prescribing lithium?

Before starting lithium obtain baseline complete blood cell counts with differential (CBC with diff); urinalysis; blood urea nitrogen; creatinine; serum calcium levels; thyroid function tests; and pregnancy test for females of childbearing age. Monitor for lithium toxicity at every visit.

Which instruction is most important to a patient on lithium therapy?

Take lithium exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the extended-release tablet whole; do not split, chew, or crush it. Your doctor may increase or decrease the dose of your medication during your treatment.

What are the two major long-term risks of lithium therapy?

Lithium also exerts antisuicidal, immunomodulatory, and neuroprotective effects. The main problems associated with long-term lithium treatment include kidney, thyroid, and probably cognitive issues.

How does lithium affect mental health?

Lithium helps reduce the severity and frequency of mania — the elevated, euphoric end of the mood scale — and may help to treat bipolar depression. If you have been at risk of suicide, lithium may help reduce these feelings. Lithium also helps prevent manic and depressive episodes occurring in the future.

Why is lithium controversial?

Since its introduction, the prescription of lithium has grown increasingly controversial due to reports of poisoning, memory loss, and the drug having a “lobotomizing effect” on patients.

What does lithium do to the brain?

At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; however, these broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes.

What are precautions for using lithium?

Call your doctor right away if you have diarrhea, vomiting, drowsiness, muscle weakness, tremors, unsteadiness, or other problems with muscle control or coordination. These may be symptoms of lithium toxicity. Make sure your doctor knows if you have a heart disorder called Brugada syndrome.

What are 3 of the common early signs of lithium toxicity?

Symptoms of lithium toxicity include severe nausea and vomiting, severe hand tremors, confusion, and vision changes. If you experience these, you should seek immediate medical attention to check your lithium levels.

How can lithium toxicity be prevented?

Lithium intoxication can be avoided by conservative dosing, care in combining drug therapies, regular clinical observation, monitoring drug plasma concentrations, and educating patients and caregivers to recognize early signs of intoxication.

What drugs Cannot be taken with lithium?

The most commonly prescribed drugs that have the potential to interact with lithium are ACE inhibitors, angiotensin II receptor antagonists (sartans), diuretics, and non-steroidal anti-inflammatory drugs (NSAIDs).

Can lithium cause permanent brain damage?

Rarely, lithium is reported to cause irreversible, permanent neurological sequelae such as cerebellar impairment, dementia, parkinsonian syndromes, choreoathetosis, brain stem syndromes, and peripheral neuropathies.

What is normal lithium level for bipolar?

For adults with bipolar disorder there was consensus that the standard lithium serum level should be 0.60‐0.80 mmol/L with the option to reduce it to 0.40‐0.60 mmol/L in case of good response but poor tolerance or to increase it to 0.80‐1.00 mmol/L in case of insufficient response and good tolerance.

Does lithium cause long-term damage?

With long-term use, lithium can cause chronic tubulo-interstitial nephritis, which is characterized by a decrease in the glomerular filtration rate (GFR) and may lead to chronic kidney disease (lithium nephropathy) (97, 98).

How do you know if you have lithium toxicity?

Mild symptoms: nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L)[33] [34]. Moderate intoxication: confusion, agitation, delirium, tachycardia, and hypertonia (serum lithium concentration between 2.5-3.5 mEq/L)[33] [34].

Can lithium cause mental impairment?

Lithium has been associated with impaired memory, word finding difficulties, and impaired recall. Often, my patients have reported a cognitive "dulling" and a loss of cognitive "creativity" with lithium use that they found most disturbing.