Lithium – Patient information

These commentaries are based on Dr Gillman’s peer reviewed scientific papers, see Publications


Lithium is safe, if guidelines are followed. The difference between the right dose and too much is small; so it is important to attend regular appointments for checkups and also blood tests and only ever take the prescribed dose.

Dose and blood tests

One specified doctor should be in charge of all blood tests etc so there is no confusion. Lithium Blood level tests must be done after you have been on the same dose for at least one week. It must be done twelve hours (11-13 hrs is OK) after the night time dose of lithium; if you take a morning dose delay it until after the blood has been taken. Keep a record of Lithium tests, and when it is due. The usual range is about 0.4-0.8 mmol/l.

Lithium and other drugs

The following drugs may alter your blood lithium level.


  1. Fluid tablets (diuretics).
  2. Arthritis tablets (NSAIDs).
  3. One sort of blood pressure tablet (ACE inhibitors).

Side effects

Tell the doctor if:–

  1. Passing more urine. Do not drink less in order to try to prevent yourself passing so much urine.
  2. Tremor: Many people develop at least some fine shakiness of the hand with lithium.
  3. Weight Gain: Most people gain at least some weight with lithium and it may be necessary modify your diet. Keep a record of your weight.
  4. Low energy, nausea, a metallic taste, loose stools.
  5. The risk of becoming ‘hypothyroid’ is about 10% overall and about 20% for women over 40 years.

Serious side effects (Toxic effects)

These are mostly caused by insufficient doctor visits for checkups and blood tests. Such symptoms may also be brought on by becoming severely dehydrated, taking too many lithium tablets or other drugs that upset your lithium levels. If you get any of the following symptoms stop lithium and consult a doctor urgently.

  1. Severe vomiting or diarrhoea.
  2. Excessive unsteadiness or shakiness.
  3. Excessive apathy / weakness, drowsiness or confused thinking.

Illness management

Specialist consultation is advisable before you start Lithium and regularly while you are on it. 3 monthly– Medical review and lithium blood level. 12 monthly for various thyroid and kidney tests. The frequency may vary and other tests may also be needed. Lithium should not be stopped abruptly.

Pregnancy and surgery

Lithium may slightly increase the risk of fetal abnormalities, if there is a possibly of becoming pregnant discuss this with your doctor. There can be problems with surgery whilst on lithium, so you should make sure that the surgeon / anaesthetist treating you know that you are taking lithium.


1. Nunes, MA, Viel, TA, and Buck, HS, Microdose lithium treatment stabilized cognitive impairment in patients with Alzheimers disease. Curr Alzheimer Res, 2012.

2. Miller, NL, Durr, JA, and Alfrey, AC, Measurement of endogenous lithium levels in serum and urine by electrothermal atomic absorption spectrometry: a method with potential clinical applications. Anal. Biochem., 1989. 182(2): p. 245-9.

3. Folkerd, E, Singer, DR, Cappuccio, FP, Markandu, ND, et al., Clearance of endogenous lithium in humans: altered dietary salt intake and comparison with exogenous lithium clearance. Am. J. Physiol., 1995. 268(4 Pt 2): p. F718-22.

4. Lehmann, K, Endogenous lithium levels. Pharmacopsychiatry, 1994. 27(3): p. 130-2.

5. Knudsen, NN, Schullehner, J, Hansen, B, Jørgensen, LF, et al., Lithium in Drinking Water and Incidence of Suicide: A Nationwide Individual-Level Cohort Study with 22 Years of Follow-Up. International Journal of Environmental Research and Public Health, 2017. 14(6): p. 627.

6. Kessing, LV, Vradi, E, and Andersen, PK, Nationwide and population-based prescription patterns in bipolar disorder. Bipolar Disord, 2016. 18(2): p. 174-82.

7. Leblanc, J-C, Dietary exposure estimates of 18 elements from the 1st French Total Diet Study. Food additives and contaminants 22.7: 624-641. 2005.

8. Anon, Second French Total Diet Study (TDS 2): Report 1 Inorganic contaminants, minerals, persistent organic pollutants, mycotoxins and phytoestrogens. 2012: p.

9. Ioannidis, J, Lies, Damned Lies, and Medical Science. Atlantic, 2010. November 17th.

10. Ioannidis, JP, Why most published research findings are false. PLoS Med, 2005. 2(8): p. e124.

11. Ioannidis, JPA, The Reproducibility Wars: Successful, Unsuccessful, Uninterpretable, Exact, Conceptual, Triangulated, Contested Replication. Clin. Chem., 2017. 63(5): p. 943-945.

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