LITHIUM THERAPY

What is Manic Depression?

Manic Depressive Psychosis is an illness marked by severe and often dramatic mood swings. These consist usually of periods of mania, which fluctuate with periods of depression and periods of stability during which the sufferer often behaves and reacts in a perfectly normal manner. Some of the more common symptoms of mania and depression are listed below.

Lithium carbonate is an important treatment used widely by psychiatrists to treat several psychiatric conditions. Its main use is as a prophylactic, or preventative medication in the treatment of manic depression.

What is Lithium?

Lithium is a natural substance. it occurs naturally in food and water, and therefore small amounts can be found in the body. Certain minerals, however, have a high Lithium content and it is from this source that the medication Lithium carbonate is made. When prescribed by a doctor, the medication can be termed simply 'Lithium carbonate' or 'Lithium citrate.' However, most manufacturers sell the medicine under a trade name. In the United Kingdom common trade names for Lithium carbonate include:

How Does Lithium Work?

Manic Depression is thought to be caused by chemical imbalances in certain brain cells responsible for emotions and behaviour. Lithium acts to correct these imbalances and therefore stabilise sufferers' moods. In doing so, Lithium causes little, if any, interference with mental or physical capacity and sufferers continue to have normal emotional reactions. For this reason, it is often better tolerated by the body than other medications used to treat manic depression.

Beginning Lithium

Before beginning Lithium therapy, it will be necessary to consult closely with your doctor to ensure that they will be able to treat you safely and effectively. Some of the information your doctor will need includes:

Your medical history - Do you have other medical conditions (for example, heart disease, thyroid disease, kidney disease, psoriasis or epilepsy)? Do you have any history of psychiatric illness in your family, especially mania or depression?

Other medications - Any medication, including non-prescribed drugs, may be important. Treatment of asthma, high blood pressure or water retention (swelling or oedema) are particularly relevant to Lithium treatment.

Your normal diet - How much alcohol do you normally consume? Do you drink large amounts of coffee or tea? Are you on a limited salt diet of any type? Are you on, or are you planning to begin any special diet?

Your work or leisure activities - Do they involve performing delicate tasks with your hands? Do you need to drive or operate dangerous machinery (sometimes Lithium impairs co-ordination)? Have you easy access to a toilet? (Lithium can cause increased urination).

This is not a comprehensive list of the information your doctor may need. It is important that you mention any information which you feel may be relevant, however slight it may be.

Tests

Before starting Lithium treatment, it may be necessary for you to undergo a number of tests to ensure that the medication can be used safely and to provide an accurate picture of how your body system functions. The type and number of tests will vary according to your medical condition and the doctor's preference, but they may include:

Blood Tests

Once you have begun treatment, it will also be necessary for you to have regular blood tests (sometimes called 'a lithium level', a 'serum lithium level' or a 'plasma lithium level'). This test is important because it enables the doctor to monitor the amount of Lithium in the bloodstream, and therefore, to ensure that your dosage is both effective and safe. Blood tests are needed more often in the early stages of treatment or when your dosage is adjusted. In these circumstances, blood tests may be needed at least once a week. Once serum levels have stabilised, they will be needed only once a month and even less frequently later. Your doctor may, however, request a blood level check if there are signs that the manic depression disorder is returning (a sign that the Lithium level may be too low) or if there is an increase in side effects (a sign that the Lithium level may be too high).

It is worth mentioning in summary that patients undergoing Lithium therapy are not always given blood tests as often as they should be, and that the effectiveness of the medication can be reduced as a result.

How long does Lithium take to work?

Lithium does not always work quickly. It can take anything from a few days to several weeks for any noticeable improvement to take place. Although some people feel better as soon as they begin Lithium, most improve more gradually.

Are there any side effects?

Like other drugs lithium may cause side effects. Some are relatively mild and occur during the initial adjustment period. Others take longer to materialise but are easy to handle. Some side effects however indicate that Lithium levels in the body have become unacceptably high.

DIET GUIDELINES - ENSURE THAT YOUR DIET INCLUDES PLENTY OF SALT AND WATER

TO MAINTAIN WATER BALANCE

Drink four to six pints of fluid a day. Cut down on tea, coffee or cola drinks which contain caffeine. Caffeine causes water loss which interferes with lithium. Reduce sugary drinks which will tend to put on weight.

TO AVOID EXCESSIVE LOSS OF WATER AND SALT

Avoid situations where you are likely to sweat heavily, such as too much activity in hot weather, using saunas or taking heavy exercise. Let your doctor know if you have a severe fever causing you to sweat heavily. Contact your doctor if you are vomiting or have diarrhoea.

TO MAINTAIN SALT BALANCE

Ensure that your diet contains an average amount of salt. Tell your doctor and get his advice before starting a diet. Do not go on a low salt diet. Do not fast when taking lithium.

TO AVOID DANGEROUS DRUG COMBINATIONS

Tell your doctor about any medication you are taking particularly if you are taking diuretics (water pills ). Never stop taking Lithium abruptly. It should be withdrawn gradually, preferably under medical supervision.

ALWAYS CONTACT YOUR DOCTOR IMMEDIATELY IF YOU THINK

YOUR LITHIUM LEVEL MAY BE TOO HIGH